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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320155
Report Date: 07/13/2023
Date Signed: 11/13/2023 10:43:41 AM

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
12/07/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20221207171043
FACILITY NAME:REM CALIFORNIA LLC - BALTICFACILITY NUMBER:
198320155
ADMINISTRATOR:WHITLEY JOHNFACILITY TYPE:
735
ADDRESS:2800 BALTIC AVETELEPHONE:
(562) 424-9555
CITY:LONG BEACHSTATE: CAZIP CODE:
90810
CAPACITY:3CENSUS: 3DATE:
07/13/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:DIRECTOR VERRETTA BOATNERTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff isolate residents for an unreasonable time period
Staff withheld resident meals
Staff are not adequately trained
INVESTIGATION FINDINGS:
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THIS REPORT SUPERSEDES THE REPORT DATED 07/13/2023 FOR CLARIFYING THE CIRCMSTANCES FOR ALLEGATION. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to REM California LLC -Baltic facility on 07/13/2023 and was greeted by Director Verretta Boatner (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
Investigation consisted of: LPA Calderon interviewed Director Verretta Boatner A1, S1-S2, R1-R3. These interviews were conducted on 07/13/2023. On 07/13/2023 LPA Calderon obtained and reviewed copies of the following: Medication Administration Records (MAR) for R1-R3 for (October, November and December 2022), MAR training records for staff (dated 12/22/2022), physician orders for R1-R3 (dated 11/16/2020), Needs and Service plan for R1-R3 (dated 4/14/21, 11/2/21 and 11/5/20), Staff training: verbal communications (dated 06/23/2023),medication errors (dated 12/22/2022), mood changes (dated 02/17/2023), Meal Plan (dated 07/03 to 07/23/2023)and incident reports for R1-R3 from 11/6/22, 1/17/23, 5/28/23 and 6/25/23. On 09/21/2023 LPA Calderon reviewed Individual Service Plan (ISP) for R1-R3 (dated 08/04/2023).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
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 3
Control Number 11-AS-20221207171043
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: REM CALIFORNIA LLC - BALTIC
FACILITY NUMBER: 198320155
VISIT DATE: 07/13/2023
NARRATIVE
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The investigation revealed the following: Regarding Allegation #1: Staff isolated residents for an unreasonable period.This complaint alleged facility staff isolated R1 for an unreasonable period. LPA Calderon conducted an interview with A1. A1 expressed that staff does not isolate residents inside their room. A1 expressed that resident room doors have no lock, and residents can come and go as they please. A1 expressed that residents have health issues and staff are trained to redirect resident actions (communication and mood training (dated 06/23/2023 and 02/17/2023) when needed and there is no reason to isolate any resident. A1 expressed that other than leaving the facility without staff residents can go into the back yard when they would like. LPA Calderon conducted an interview with S1-S2. S1 expressed that at no time has any staff member locked R1 or any other resident inside their room. S1 expressed that staff are trained to redirect residents’ actions. S2 expressed that there is no lock on residents’ doors and residents can come and go as they please. S2 expressed that A1 provided training on how to redirect residents’ actions (dated 02/17/2023) and there is no need for any resident to be isolated from other residents or staff. LPA Calderon conducted an interview with R1-R3. 3 out of 3 residents expressed that staff has never locked residents inside their room or ever isolated residents from other staff or other residents. 3 out of 3 residents expressed that there is no lock on their bedroom doors, and they can come and go inside the facility as they please. On 07/13/2023 LPA Calderon toured the facility and noted residents moving around from their bedrooms to the living room to watch TV and into the kitchen area. LPA Calderon noted that residents left the facility for doctor’s appointment and day program. On 07/13/2023 LPA Calderon reviewed 4 incident reports dated 11/6/22, 1/17/23, 5/28/23 and 6/25/23. Incident reports do not report R1, or any other resident being isolated from staff. On 07/13/2023 LPA Calderon reviewed needs and service plan for R1-R3. 3 out of 3 residents have health issues. On 07/13/2023 LPA Calderon reviewed training records for staff: Training for verbal communications (dated 6/23/23), which state “STOP” Stop remember to pause, take a few breaths, and refocus, observe your present state without judging it, proceed with awareness and understand. On 09/21/2023 LPA Calderon reviewed ISP plan for R1-R3 (dated 08/04/2023) ISP plan expressed that staff redirect verbally when R1-R3 are experiencing a behavioral episode. Staff will have a conversation with R1-R3 when not following directions. There is no consequence for R1-R3 is non-compliant only redirection.Regarding Allegation #2: Staff withheld residents’ meals.This complaint alleged facility staff withheld residents’ meals. LPA Calderon conducted an interview with A1. A1 expressed that at no time does staff withhold food from R1. A1 said that staff provide 3 meals per day and snacks. A1 also expressed that R1-R3 provide snacks at day program. A1 expressed that R1-R3 have access to the kitchen and food if they are hungry. A1 expressed that R1-R3 are diabetic and there is a meal plan generated weekly for residents. A1 expressed that staff would not withhold food from residents due to R1-R3 acting out and having to be redirected. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff expressed that staff provide 3 meals and snacks per day and that no resident is denied food for any reason. S1-S2 expressed that R1-R3 have access to the kitchen and can access snacks when they are hungry.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20221207171043
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: REM CALIFORNIA LLC - BALTIC
FACILITY NUMBER: 198320155
VISIT DATE: 07/13/2023
NARRATIVE
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LPA Calderon conducted an interview with R1-R3. 3 out of 3 residents said that staff provide them with 3 meals per day and snacks. 3 out of 3 residents expressed that if R1-R3 are hungry staff will provide R1-R3 with additional food to eat. On 07/13/2023 reviewed meal plan for the week of (dated 7/3/23 to 7/23/23). LPA Calderon noted detailed meal plan for breakfast, lunch, and dinner. On 07/13/2023 LPA Calderon toured the facility with A1. LPA Calderon noted meals being served to residents and noted R1 going into the kitchen and opening the refrigerator and taking out snacks to eat. LPA Calderon noted residents eating food in the dining room and returning to the kitchen and cleaning their dishes. LPA Calderon noted staff cooking dinner for residents. On 09/21/2023 LPA Calderon reviewed ISP plan for R1-R3 (dated 08/04/2023) ISP plan expressed that staff redirect verbally when R1-R3 are experiencing a behavioral episode. Staff will have a conversation with R1-R3 when not following directions. There is no consequence for R1-R3 is non-compliant. Regarding Allegation #3: Staff are not adequately trained.This complaint alleged staff are not adequately trained.LPA Calderon conducted an interview with A1. A1 expressed that when staff are hired there is training given to staff regarding medication administration record (MAR) (dated 12/22/2022), verbal communications (dated 06/23/2023), mood changes (dated 02/17/2023). A1 expressed that additional training is given monthly or when needed. A1 expressed that all staff are given MAR training and when there is an error additional training is given to all staff. A1 said that any MAR errors are reported when they happen additional training is given to all staff. A1 expressed that no administrator, director, or manager has told caregivers that they would be fired if they reported MAR mistakes. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff expressed that administrator or director gives them training monthly regarding medication administration record (MAR) (dated 12/22/2022) and redirecting residents for mood changes (dated 01/17/2023). verbal communication training (dated 6/23/2023). S1-S2 expressed that additional training is given when an error is made regarding medication. S1-S2 expressed that A1 has not advised staff to not report medication errors when they happen or to generate an incident report for the medication error. On 07/13/2023 LPA Calderon reviewed Medication Administration training (MAR) (dated 12/21/2022) which states there are 6 principles of medication administration. Give medication administration your complete attention, administer medication in a quite area, free from distractions. Never leave medications unattended, administer medication one client at a time, the staff who starts administering the medications should finish administrating the medications.Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “Staff isolate residents for an unreasonable time period” “Staff withheld residents’ meals” “Staff are not adequately trained” is found to be UNSUBSTANTIATED. An exit interview was conducted and copy of the Complaint Report were provided to the Director Verretta Boatner (A1)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3