198320092-8-2-2023-11-AS-MVAO-CVMRMQ-20230913130907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320092
Report Date: 08/02/2023
Date Signed: 08/02/2023 05:10:34 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
07/28/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230728163510

FACILITY NAME:	LIFESTYLE BOARD AND CARE		FACILITY NUMBER:	198320092
ADMINISTRATOR:	ANGELES, JENNYLYN		FACILITY TYPE:	735
ADDRESS:	149 EAST 235TH STREET		TELEPHONE:	(562) 743-1037
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	6	CENSUS: 4	DATE:	08/02/2023
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Kim Manor		TIME COMPLETED:	03:14 PM

ALLEGATION(S):

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Facility staff does not allow resident to wear clothing of their choice.

INVESTIGATION FINDINGS:

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On 08/02/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint visit at this facility. LPA met with administrator Kim Manor. LPA explained the purpose of the visit is to investigate the allegation mentioned above.

Investigation consisted of the following: Interviews with staff #1 -#2 (S1-S2) and clients #1-#4 (C1-C4), a review of client #1 (C1's) Admission Agreement, Appraisal/Needs and Service Plan, Physician's Report, Medical and Dental Service, Medication, Daily Progress Notes, and House Rules. A tour of the facility.

Evaluation Report continues LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230728163510

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: LIFESTYLE BOARD AND CARE	FACILITY NUMBER: 198320092
	VISIT DATE: 08/02/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff does not allow resident to wear clothing of their choice.

The details of the complaint alleged staff #1 (S1) regulates client #1 (C1) clothing of choice. The complainant reported that (S1) is not allowing (C1) to wear shorts - clothing shorter than knee length when it is appropriate for the weather.

The Department interviewed client #1 (C1) and disputed this allegation. (C1) reported a closet full of a variety of styles of clothing and can wear whatever (C1) desire without any interference from (S1). Interviews with (S1-S2) denied this allegation. (S1-S2) stated it is the client's right to wear whatever choice of clothing garments they wish. (S1) claimed not to have any influence on what (C1) should be wearing at the group home or out in the community. Interviews with clients #2 - #4 (C2-C4) reported having no concerns or issues with this matter. (C2-C4) reported there are House Rules that we must abide by. However, the clothing of choice is not restricted at this group home.

A review of (C1's) Physician's Report dated 11/09/21, (C1) is independent and capable to care for all personal needs including dressing oneself. (C1's) service plan does indicate that reminders of daily routines, monitoring, supervision, and encouragement are noted in (C1's) Appraisal/Needs and Service Plan dated 04/04/23.

Based on the information gathered, an inspection of the facility, observation, and interviews conducted, documents reviewed, the Department found no evidence to support the allegation mentioned above.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Kim Manor and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC9099 (FAS) - (06/04)

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