198320231-6-12-2024-11-AS-UCOL-D7ASLY-20240718135903

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320231
Report Date: 06/12/2024
Date Signed: 06/12/2024 02:11:17 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
06/05/2024 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240605145113

FACILITY NAME:	REM CALIFORNIA, LLC - ATHERTON		FACILITY NUMBER:	198320231
ADMINISTRATOR:	DIAZ, JESSICA		FACILITY TYPE:	735
ADDRESS:	6927 ATHERTON STREET		TELEPHONE:	(562) 343-7211
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	3	CENSUS: 3	DATE:	06/12/2024
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Jessica Diaz, Program Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff hit resident.
Staff intimidated residents.
Staff do not ensure furniture used by residents is in good repair.
Staff do not ensure an adequate supply of food is available for residents

INVESTIGATION FINDINGS:

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On 06/12/2024 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Jessica Diaz, Program Director (S4), and the purpose of the visit was explained. LPA requested and reviewed Individual Person-Centered Plan (IPP) for two (2) clients (C1-C2), staff roster (LIC500) and Register of Clients (LIC9020), In-Service training held on 02/02/2024, and unusual incident report (SIR) of 06/05/2024 and interviews were conducted and LPA toured the facility.
The investigation consisted of the following:
On 06/12/24 LPA requested and reviewed facility documents and toured the facility. LPA interviewed four (4) out of eleven (11) staff and 2 out of three (3) clients. One (1) client is non-verbal.

Report continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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-20240605145113

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: REM CALIFORNIA, LLC - ATHERTON	FACILITY NUMBER: 198320231
	VISIT DATE: 06/12/2024

NARRATIVE

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The investigation revealed the following:

Regarding the allegation: "Staff hit resident.", it has been alleged that staff had punched resident(s) in the head, dates unknown. Between 8:30AM and 11:30AM, on 06/12/2024, LPA was provided documents as listed above and interviewed individuals as listed above. Between 08:30AM and 9:00AM, 06/12/2024, LPA observed client one (C1) as being a physically strong and assertive, non-verbal, client. Record reviews revealed that 11 out of 11 staff had been trained on the Zero-Tolerance Abuse/Neglect policy and Mandated Reporting on 02/02/2024. LPA reviewed behavior logs of all 3 clients and body check logs of C1 from 04/01/2024 through 04/30/2024. LPA reviewed IPP of C1 and C2, both noting factors of property destructive behaviors, while C1's IPP noting of self-injurious behavior (SIB). LPA observed and verified C1's body check log matches with C1's physical body. Interviews revealed that 4 out of 4 staff and 1 out of 2 clients have denied the allegation had taken place, while C1 is non-verbal.
Based on record reviews, LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation “Staff intimidated residents.”, it has been alleged that staff intimidates residents with threatening item(s). Between 8:30AM and 12:30PM, on 06/12/2024, LPA observed normal staff functions at the above-mentioned Adult Residential Facility and behaviors of developmentally disabled clients. Record reviews revealed that 11 out of 11 staff had been trained on the Zero-Tolerance Abuse/Neglect policy and Mandated Reporting on 02/02/2024. Interviews revealed that 4 out of 4 staff and 1 out of 2 clients have denied the allegation had taken place, while C1 is non-verbal.
Based on record reviews, LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Report continues, see LIC9099C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240605145113

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: REM CALIFORNIA, LLC - ATHERTON	FACILITY NUMBER: 198320231
	VISIT DATE: 06/12/2024

NARRATIVE

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Regarding the allegation ”Staff do not ensure furniture used by residents is in good repair.”, it has been alleged that resident(s) beds are broken. Between 08:30AM and 09:30AM, LPA observed all 3 client beds to be maintained in good repair. LPA conducted record reviews as follows: LPA reviewed IPP of C1 and C2, both noting factors of property destructive behaviors, while C1's IPP notes of self-injurious behavior (SIB). Record reviews also revealed that 2 bed frames, 1 box spring (Full-Sized) and 1 mattress and box-spring (King-Sized) were delivered and installed on Friday, 06/07/2024, after 2 clients had broken their bed frames over time. C2's previous bed frame was delivered on 03/07/2024. Interviews revealed that 4 out of 4 staff and 1 out of 2 clients have denied the allegation had taken place, while C1 is non-verbal.
Based on record reviews, LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation “Staff do not ensure an adequate supply of food is available for residents.”, it has been alleged that there is not enough food available for residents in care. Record reviews revealed that additional food and drinks were purchased on 06/11/2024, by S4. Between 1:30PM and 2:00PM LPA observed adequate supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days maintained on the premises, which is enough food for all 3 residents. Interviews revealed that 4 out of 4 staff and 1 out of 2 clients have denied the allegation had taken place, while C1 is non-verbal.
Based on record reviews, LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been no deficiencies cited during today's visit.

An exit interview was held with Jessica Diaz, Program Director (S4), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC9099 (FAS) - (06/04)

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