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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320083
Report Date: 05/08/2023
Date Signed: 05/08/2023 03:23:22 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2023 and conducted by Evaluator Martessa Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230502090033
FACILITY NAME:DUPE HOME CARE SERVICESFACILITY NUMBER:
198320083
ADMINISTRATOR:MORGAN, DEBORAHFACILITY TYPE:
735
ADDRESS:5879 & 5881 ESTRELLA AVETELEPHONE:
(323) 291-1355
CITY:LOS ANGELESSTATE: CAZIP CODE:
90044
CAPACITY:12CENSUS: 9DATE:
05/08/2023
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Donna Eko AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff does not ensure resident seeks medical attention when requested.



INVESTIGATION FINDINGS:
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On 05/8/23 Licensing Program Analyst(LPA) Martessa Brown conducted an unannounced visit regarding the above allegation. LPA arrived at the facility and greeted by Marty Eko-Staff Manager and later was met by the Administrator Donna Eko, And the purpose of the visit was explained.

The investigation consisted of the following: LPA toured the facility. Conducted interviews with Administrator and Staff (S1) and Clients (C1-C5). Requested incident reports related to the above allegation. LPA obtained and reviewed client and staff roster, (C1-C2) Admission agreements, Recent Physicians Reports, Appraisal Needs/Service and Emergency Contact.

Regarding Allegation: Staff does not ensure resident seeks medical attention when requested.

Investigation revealed the following:
Lic 9099-C is on the next page.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20230502090033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: DUPE HOME CARE SERVICES
FACILITY NUMBER: 198320083
VISIT DATE: 05/08/2023
NARRATIVE
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Investigation revealed the following:

It was alleged the facility staff does not seek medical attention for resident in care and are suspicious. On 5/8/23, LPA conducted interviews with clients C1-C5. 4 out of 5 clients stated they do not have a concern with staff seeking medical attention when needed. 4 out of 5 clients stated they have not seen any clients needing medical attention and not being assisted. LPA conducted interviews with Administrator and S1. Administrator and S1 stated 2 clients are seen by physicians at the facility. The remaining clients are from project 180 and physicians visits are schedule by their case managers. Staff stated in the event a client has a medical emergency 911 is called. Administrator stated 2 clients that are seen by the physician for treatment will need to have a referral if need to be seen by a specialist and dentist. LPA reviewed C1's most recent physician’s report and was seen by the physician 3/14/23. Based on documentation and interviews LPA did not observe staff not seeking medical attention for clients, the above allegation is unsubstantiated.

Therefore; based on Interviews, Record Review, and Observation the department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

No citations issued during this visit, and exit interview conducted, and a copy of this report was provided to Donna Eko.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2