198320092-8-4-2023-11-AS-JHAD-CW8S9G-20231002134040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320092
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:41:32 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
07/27/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230727163632

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:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Jaime Fernandez		TIME COMPLETED:	11:32 AM

ALLEGATION(S):

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Staff yelled at client.
Staff do not provide client with toilet paper.
Staff do not administer client's medication as prescribed.

INVESTIGATION FINDINGS:

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On 08/04/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint visit at this facility. LPA met with caregiver Jaime Fernandez. Fernandez contacted administrator Kim Manor who could not be present for this visit. LPA explained the purpose of the visit is to investigation the allegations 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 Logs, Daily Progress Notes, House Rules, and copy of a 30-Day Eviction Notice. 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: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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-20230727163632

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: 08/04/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff yelled at client.

The details of the complaint reported staff #1 (S1) yells at client #1 (C1). The complainant reported that (S1) yells at (C1) and has witnessed (S1) yell at others.

The Department interviewed (C1) on 08/02/23, who claimed that (S1) does not yell at (C1). (C1) has not observed (S1) created a hostile environment at the group home. (C1) recalled (S1) being stern when it comes to abiding by house rules but has never encountered (S1) being disrespectful to others. Interviews with clients #2-#4 (C2-C4) were unable to corroborate this accusation. (C2-C4) stated (S1) creates a safe environment at this group home. Interviews with staff #1-#2 (S1-S2) both denied this claim. (S1) stated she respects all clients at the home and is fully aware of their rights and it is not necessary to yell at them to control another person or a situation. (S2) is complimentary of (S1) professionalism and friendliness towards each client. Based on the information gathered, no evidence exists to support the allegation mentioned above.

Allegation: Staff do not provide client with toilet paper.

The complainant reported that staff #1 (S1) does not make hygiene supplies available for client #1 (C1) and must self-purchase while out in the community.

The Department interviewed (C1) on 08/02/23, who claimed this accusation is untrue. (C1) reported that (C1) has never had to self-purchase hygiene supplies as they are available to everyone at home. The supplies are accessible in cabinets and drawers in the home. (C1) claimed not to be limited to hygiene resources. Interviews with clients #2-#4 (C2-C4) stated that hygiene supplies have never been restricted. (S1-S2) disagreed with this claim. (S1) reported hygiene supplies are always accessible to clients in unlocked drawers and cabinets and have never run out of resources. Based on the information gathered, no evidence exists to support the allegation mentioned above.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230727163632

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: 08/04/2023

NARRATIVE

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Allegation: Staff do not administer client's medication as prescribed.

The details of the complaint alleged client #1 (C1) is not provided daily medications. According to the complainant (C1) exhibits behaviors that have never been present before and accounts for missed medications.

The Department interviewed (C1) on 08/02/23, who claimed (C1) received all prescribed medications and there have never been issues with the staff assisting with (C1’s) medication intakes and the staff has ever run out of medication or supplements.

Interviews with staff #1-#2 (S1-S2) stated there have been occasions when (C1) had refused to take medications. Staff will assist with prepping and encourage (C1), but there will be times when (C1) does not want to cooperate, and the staff will notify the physician and social worker. (C1) has the right to refuse medications as their right. (S1) stated the staff explained to (C1) the reason for taking the medication and the possible effects on one’s health if medication is not taken. After a few minutes, the staff will ask (C1) to take the medication again.

Interviews with clients #2-#4 (C2-C4) had no concerns or issues with medications and commented that staff assists and have never refused or run out of medications. After reviewing (C1's) service records, the Department determined that (C1) is independent, capable of self-care, and is not confused, able to follow instructions, and able to communicate.

The Department audited (C1’s) mediation administration records and it revealed (C1) to have taken prescribed medications consistently. It is documented when (C1) refused medications in (MAR). A professional physician and the social worker was notified. Based on the gathered information, the allegation mentioned above cannot be supported.

Based on the information collected, an inspection of the facility, observation, record reviews, and interviews conducted, the Department found no evidence to support the allegations for this complaint.

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

An exit interview was conducted with Jaime Fernandez, and copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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