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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320223
Report Date: 10/17/2024
Date Signed: 10/17/2024 01:47:06 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
10/10/2024 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241010103153
FACILITY NAME:EMILY'S HOMECAREFACILITY NUMBER:
198320223
ADMINISTRATOR:FIGUEROA, PATRICKFACILITY TYPE:
735
ADDRESS:603 W. 235TH STTELEPHONE:
(310) 938-6193
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:4CENSUS: 4DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
12:32 PM
MET WITH:Patrick Figueroa, Administrator/LicenseeTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are no ensuring that resident’s room are kept clean and sanitary.
INVESTIGATION FINDINGS:
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On 10/17/2024 at 12:32pm, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond initiated an unannounced complaint investigation for the allegation listed above.

During today’s visit, LPA and LPM met with Patrick Figueroa (Administrator/Licensee) and the purpose of the visit was explained.

The investigation consisted of the following:

On 10/17/2023, LPA and LPM interviewed Administrator (A1), Staff #1 (S1) and Client #1- #2 (C1 – C2).

LPA, requested copies of the staff roster and resident roster (dated on 10/17/2024)

On 10/17/2024, LPA and LPM did a tour of the physical plant.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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 2
Control Number 11-AS-20241010103153
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: 10/17/2024
NARRATIVE
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On 10/17/2024 at 12:35pm, LPA interview the Administrator (A1), regarding the above allegation.
A1 stated that he ensures that the facility is cleaned every day.


On 10/17/2024 between the time of 12:35pm – 12:45pm, LPA interview Staff # 1 (S1)– Staff 2 (S2) regarding the allegation. The administrator and the staff were interviewed, and unaware of the allegation.

On 10/17/2024 between the time 12:50pm – 1:00pm interviewed clients #1 - #2, due to the communication barriers, C1 and C2 are only able to nod head when asked interview questions. 2 of 2 client interviews, nodded that their rooms are cleaned by facility staff. LPA was unable to interview client 3 and client 4 due to communication barriers.

On 10/17/2024 at 1pm, LPA did a physical tour which consisted of inspecting the living room, dining room, client rooms #1-#4 and the facility appeared to be cleaned.

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

Exit interview conducted with Patrick Figueroa (Administrator) and copy of the report.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2