198320223-10-2-2024-11-AS-JHAD-D9UMPE-20241008094703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320223
Report Date: 10/02/2024
Date Signed: 10/02/2024 03:29:43 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
09/30/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240930155203

FACILITY NAME:	EMILY'S HOMECARE		FACILITY NUMBER:	198320223
ADMINISTRATOR:	FIGUEROA, PATRICK		FACILITY TYPE:	735
ADDRESS:	603 W. 235TH ST		TELEPHONE:	(310) 938-6193
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	4	CENSUS: 4	DATE:	10/02/2024
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Patrick Figueroa		TIME COMPLETED:	01:14 PM

ALLEGATION(S):

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Facility staff are not adquately trained.

INVESTIGATION FINDINGS:

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On 10/02/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit at this facility. LPA was greeted by Administrator Patrick Figueroa. LPA explained the purpose of this visit was to investigate the allegation mentioned above..

The investigation consisted of the following: CCL visits conducted on 09/19/24 and 10/02/24. A tour of the physical plant, interviews, and collection of records. LPA Dabuet reviewed the following documents: Service Records for clients #1-#4 (C1-C4) and Personnel Records for staff #1-#4 (S1-S4) and Administrator (A1). Facility Resident's Roster LIC 9020 (dated: 11/07/22); Personnel Report LIC 500 (dated: 09/30/24); QA Personnel Roster, Prerequisites, Certifications & CEUs (dated: 06/01/24), Resident Council Meetings (dated: 08/01/24 & 09/01/24), Activity Log (02/01/24 – 10/01/24), Weight Records (dated: 01/01/24-10/01/24); Alternative Food Menu (dated: 09/06/24-10/06/24) and other pertinent records associated with this complaint. Interviews with clients #1-#4 (C1-C4), staff #1 and administrator (A1).
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

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-20240930155203

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: EMILY'S HOMECARE	FACILITY NUMBER: 198320223
	VISIT DATE: 10/02/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff are not adequately trained.

The details of the complaint alleged the staff at this facility may not be adequately trained calling for a concern for clients not being treated properly. There was no further information associated with this allegation.

On 10/02/24, between 9:30 am - 10: 45 am, the Department interviewed (2) out of (2) Administrator #1 (A1) and staff #1 (S1). (A1) and (S1) have indicated Direct Support Professional Training (DSP) I&II have been completed. (DSP) training consisted of 70 hours of completed training exist of various topics such as Medication Management, Communication, Incident Reporting; Risk Management, Individual Program Plans, Positive Behavior, Preventive Healthcare, Nutritional & Exercise, Making Choices, Life Quality, and many more. (A1) claimed in addition to the (DSP) training, the facility staff has completed training on Clients' Rights & Choices, Program Design Philosophy, Writing Client Reports, Medication Familiarity & Administrating Processes, Health & Emergency Procedures, Identifying & Reporting Incidents, Proactivity Safeguards; Food Service; Housekeeping; Direct Care Supervision, Abuse Reporting; Documentation Data & Collection & Response Testing Guidance for Epidemic Outbreaks. (A1) stated these courses overlap the same training with (DSP) mandatory training. (A1) reported the facility must comply with Harbor Regional Center Annual Quality Assurance Report (dated: 06/01/24) where it presents Prerequisites, Certifications, and Continuing Education Units completed by facility personnel.

As a result of the Department reviewing personnel files and QA Personnel Roster, Prerequisites, Certifications, & CEUs (dated: 06/01/24) for administrator (A1) and staff #1-#4 (S1-S4) it revealed all staff has completed (DSP) training, In-House training, and Relias HealthCare Compliance Training.

On 10/02/24, between 9:40 – 12:00 pm, the Department conducted a plant inspection of the facility. The Department observed (1) out (4) clients at the facility. Client #1 (C1) is present at the facility taking part in day program activities through virtual communications. (C2-C4) were out in the community taking part in day program activities.

On 10/02/24 at 9:30 am – 9:38 am, the Department interviewed client #1 (C1). (C1) is non-verbal and is able to carry a conversation by nodding who reported that (C1) is being adequately provided care and supervision by staff. (Evaluation Report continues LIC 9099-C)

This report serves as an amendment to clarify finding on line #4. It does not supersedes the complaint investigation findings reflected on report created on 10/02/24.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240930155203

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: EMILY'S HOMECARE	FACILITY NUMBER: 198320223
	VISIT DATE: 10/02/2024

NARRATIVE

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The Department has conducted Annual Inspection and Case Management visits on 09/19/24. The Department interviewed (4) out of (4) non-verbal clients all communicated they were being provided adequate care and supervision by staff.

On 10/01/24 between 4:00 pm – 04:30 pm, the Department interviewed (HRC) Service Coordinator witness #1 (W1). (W1) verified that (W1) is the coordinator for all (4) clients at this facility. (W1) communicated that (W1) had no concerns or issues with the care and supervision provided by the personnel staff. (W1) is complimentary of the personnel staff, asserting the facility has a track record of compliance and providing a safe residential home for the clients.

During inspections on 09/19/24 and 10/02/24, the Department observed Resident Council Meetings (dated: 08/01/24 & 09/01/24), Activity Log (02/01/24 – 10/01/24), Weight Records (dated: 01/01/24-10/01/24); Alternative Food Menu (dated: 09/06/24-10/06/24), (CCL) Mandated Posters posted, perishable and non-perishable food maintained sufficiently. Medication Records Administration (MAR) is complete and accurate. Emergency Kit available for each client.

Based on the gathered information, there is no evidence to support the allegation mentioned above.

Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. 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 is conducted with Patrick Figueroa, and a copy of the report is provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC9099 (FAS) - (06/04)

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