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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320223
Report Date: 11/18/2024
Date Signed: 11/18/2024 07:17:09 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
11/12/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241112112301
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:
11/18/2024
UNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Patrick Figueroa TIME COMPLETED:
03:03 PM
ALLEGATION(S):
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Staff do not prevent resident from self harming.
INVESTIGATION FINDINGS:
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On 11/18/24, California Department of Social Services/Community Care Licensing (CDSS/CCL) associate conducted an initial unannounced complaint visit. (CDSS/CCL) associate was greeted by Administrator Patrick Figueroa. (CDSS/CCL) associate explained the purpose of this visit was to investigate the allegation mentioned above.

The investigation consisted of the following: A tour of the physical plant, interviews, and collection of records. Interviews with staff #1-#3 (S1-S3), clients #1-#4 (C1-C4) and witness #1-#3 (W1-W3). A review of Personnel Report LIC 500 dated: 09/30/24), Registered of Faciltiy Clients LIC 9020 (dated: 10/09/24) staff training materials and Personel Record LIC 500 (dated: 09/30/24).

(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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 3
Control Number 11-AS-20241112112301
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: 11/18/2024
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff do not prevent resident from self-harming.

The details of the complaint alleged the staff at this facility do not prevent clients from self-harming. It is reported it has been observed that one client is hurting thyself and the care staff are not doing anything to prevent it. There was no further information associated with this allegation.

On 11/18/24, between 12:45 pm – 01:30 pm, the Department interviewed (2) out of (4) clients who were unable to validate this claim. (C1-C2) claimed that their care and supervision were adequate, and they were never left alone unattended. ( C3) was present at the facility and interviewed, but (C3) was unable to hold a conversation due to his disability. (C4) was not available for an interview.



On 11/18/24, between 12:00 pm – 3:00 pm, the Department interviewed (3) out of (3) staff. who claimed this accusation is untrue. (S1-S3) are care staff who work various shifts throughout the week stated no client is neglected of care or has experience from lack of supervision. Client #1 (C1) has a history self injurious behavior, according to Harbor Regional Center Individual Person-Centered Plan (dated: 08/08/24). (C1) attends daycare program activities throughout the week and does not return until 1pm or 2pm along with client # 3 (C3). Client #4 (C4) returns from the day program after 3 pm. While client #2 (C2) remained at the facility being cared for and supervised daily by two Direct Support Professional (DSP) staff #2 -#3 (S2-S3). According to (S1-S2), the routine duties being performed while on duties consisted of assisting clients with daily activities, such as bathing, grooming, dressing, housekeeping, preparation of meals, and supervision. (S1) stated although (C1) does not require one on one care, (C1) is monitored 24-hour basis by (DSP) staff. (C1’s) behaviors are being controlled by a combination of behavioral interventions and medications. The staff have been able to reduce and redirected (C1’s) harmful behaviors with routine household chores, regular training on activities of daily living and increased social and recreational activities. (S1) reported there is never a shortage of staff. There is always two (2) Direct Support Provider (DSP) staff each shift monitoring all four (4) clients daily.

On 11/18/24 between 11:45 am – 12:30 pm, the Department interviewed (3) out of (3) witnesses who were unable to support this claim. (W1-W3) are aware of (C1’s) history of self injurious behaviors a plan is being followed by the (DSP) Direct Support Providers appropriately with 24 care and supervision. (Evaluation Report continues LIC 9099-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241112112301
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: 11/18/2024
NARRATIVE
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(W2) is the Harbor Regional Center Service Coordinator for all (4) clients stated (W2) just completed a Quarterly Inspection on 11/01/24 and observed all (4) clients appeared to be in healthy and safe conditions.

(W3) is the Clinical Behaviorist who comes to service the clients at this home weekly at various hours and claimed to have never observed any (DSP) neglect the clients care or supervision of clients at this facility. (W1-W3) complimented the facility's personnel, claimed to comply, and considered it a safe residential facility.

The Department conducted Annual Inspections, Case Management, and Complaint visits on 09/19/24, 10/02/24, 10/17/24, 10/23/24, and 11/04/24 and observed (2) DSP staff working together, executing, and providing daily activities with clients. During the prior visits, (DSP) staff have never left a client unattended or failed to supervise them.

As a result of the Department reviewing the client’s service files and personnel files for clients and staff along with staff training materials, (C1's) Physicians Report LIC 602 (dated: 06/18/24), HRC Individual Person-Centered Plan (dated: 08/08/24) verified a care plan is available to handle (C1's) behaviors and that one one care is not mandated. Based on 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: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3