198320144-1-27-2024-11-AS-JHAD-D232SB-20240201163851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320144
Report Date: 01/27/2024
Date Signed: 01/27/2024 02:31:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230724090538

FACILITY NAME:	SMITH FAMILY RESIDENTIAL CARE		FACILITY NUMBER:	198320144
ADMINISTRATOR:	BEVERLY, KIMBERLY		FACILITY TYPE:	735
ADDRESS:	10518 S. 7TH AVENUE		TELEPHONE:	(323) 777-6161
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90303
CAPACITY:	6	CENSUS: 4	DATE:	01/27/2024
		UNANNOUNCED	TIME BEGAN:	11:04 AM
MET WITH:	Kenya Brown		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Licensee does not have control of property.

INVESTIGATION FINDINGS:

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On 01/27/24, Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Administrator (S1 Kenya Brown). LPA conducted a risk assessment prior to entering the facility and observed COVID-19 protocol. S1 informed LPA that the facility has no COVID cases nor do any of the clients or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegation.

An initial 10-Day visit was conducted 07/26/23 with Administrator (S1: Kenya Brown). During this visit, LPA conducted a tour of the facility’s physical plant and observed the residents in care for health and safety purposes. Records reviewed for this complaint included the following: Service Records for clients #1-#4 (C1-C4); Property Tax Statement; US Bank and Sky One Federal Statements; Utitlies Statements, Client's Safeguard Cash Resources LIC405, Surety Bond, Residential Rental Agreement, Superior Court of California, County of San Bernardino Probate Letters, and other documents pertinent to this complaint.
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2024

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-20230724090538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY RESIDENTIAL CARE	FACILITY NUMBER: 198320144
	VISIT DATE: 01/27/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Licensee does not have control of property.

The details of this complaint alleged that the licensee did not have control of the licensed property. The complainant claimed a new change of ownership allowed for a new licensee to take over the property when the original licensee/property owner had passed away in 2020. The complainant stated that the newly licensee does not hold a lease agreement and does not have control of the property.

On 07/26/23 between 9:27 am – 1:01 pm, the Department investigated a visit to this facility and interviewed the administrator staff #1 (S1) and the licensee staff #2 (S2). (S1) and (S2) explained that Ruby Smith, the former licensee, and property owner witness #1 (W1), passed away in 09/04/20, causing the facility to change ownership.

(S1-S2) stated an Emergency Approval to Operate meeting with Community Care Licensing (CCL) was conducted on 09/11/20. On 09/18/20, documentation and records were provided to the (CCL). On 12/20/20 an application for (CCL) application for a Community Care Facility or Residential Care Facility for the Elderly License LIC 200 was processed.

On 02/18/21, the facility was licensed with the change of ownership listed on the application with staff #2 (S2) Barry Harris as the property owner.

On 07/13/23, a Probate Court Hearing for the Estate of Ruby Smith was held, and an additional Court Case Hearing was scheduled for 11/08/23. The results from the court hearing cases, provided a certified Probate Letter from the Superior Court of California, County of San Bernardino a document listing (S2) as the court appointed administrator of the decedent’s estate.

(S1-S2) claimed that there was control over the property during the transition of ownership. (S1) provided a Residential Lease Agreement with (S2) dated and signed by (S1) and (S2).

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230724090538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: SMITH FAMILY RESIDENTIAL CARE	FACILITY NUMBER: 198320144
	VISIT DATE: 01/27/2024

NARRATIVE

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Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found insufficient 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 Kenya Brown, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2024

LIC9099 (FAS) - (06/04)

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