198600265-4-30-2024-28-AS-LHIS-D5BM85-20240516092233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600265
Report Date: 04/30/2024
Date Signed: 04/30/2024 03:57:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2024 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240315084016

FACILITY NAME:	ERNIE'S PLACE		FACILITY NUMBER:	198600265
ADMINISTRATOR:	GARCIA, NOEY		FACILITY TYPE:	735
ADDRESS:	630 N. NICHOLSON		TELEPHONE:	(626) 280-7205
CITY:	MONTEREY PARK	STATE: CA	ZIP CODE:	91755
CAPACITY:	6	CENSUS: 5	DATE:	04/30/2024
		UNANNOUNCED	TIME BEGAN:	02:11 PM
MET WITH:	Karen Gazon, Administrator		TIME COMPLETED:	04:03 PM

ALLEGATION(S):

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Staff did not reorder resident's medication timely
Staff are neglecting residents medical needs

INVESTIGATION FINDINGS:

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LPA made subsequent unannounced visit to deliver findings, LPA met with Administrator Karen Gazon and discussed the purpose of the visit.

LPA made previous visit on 03/19/2024 and during that visit LPA reviewed and obtained staff and client roster, MAR for C1 for months of February and partial month of March 2024. Reviewed medication for C1, obtained last dental appointment documentation for C1, DC order for C1, PRN authorization letters for all 5 clients (C#1-C#5) interviewed Five staff (S#1-S#5) and two clients (C#1-C#2) and obtained notice of change in coverage for C1 medication.
04/30/2024 LPA reviewed and obtained MAR for March and April for C1 and proof of dental office visit. LPA took tour of entire facility during visit.

Allegation: Staff did not reorder resident's medication timely. It is alleged that facility did not order client's medication for seizures. (Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

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 28-AS-20240315084016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ERNIE'S PLACE	FACILITY NUMBER: 198600265
	VISIT DATE: 04/30/2024

NARRATIVE

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The investigation revealed: LPA Interviewed five (5) staff S1-S5 and five (5) of five(5) staff denied the allegation. LPA interviewed two (2) clients C1-C2 and two (2) of two (2) clients could not collaborate the allegation. S1 and S3 stated that client has never run out of seizure medication. LPA reviewed the MAR for C1 for February, March and April and the 2 seizures medications were administered according to doctor's orders. C1 was not out of seizure medication as alleged
There is not enough evidence to substantiate this allegation.

Allegation: Staff are neglecting client medical needs. It is alleged that facility is neglecting client dental needs by not taking client to the dentist.

The investigation revealed: LPA Interviewed five (5) staff S1-S5 and five (5) of five(5) staff denied the allegation. LPA attempted to contact S6 on 3 different dates and left voice mail for call back but call was never returned to LPA. LPA interviewed two (2) clients C1-C2 and two (2) of two (2) clients could not collaborate the allegation. S1 stated that C1 had an appointment with the dentist on 11/22/23 and was recommended sensodyne toothpaste for tooth sensitivity C1 stated C1 would buy the sensodyne toothpaste but choose to buy other items instead. S1 stated it was recommended by C1 dentist and since it is recommended and not prescribed, it is up to client to use client's own funds to purchase it. In regards to the dental appointment, S1 stated that an appointment is schedule for March 29, 2024. C1 stated that C1 can wait for C1 dental appointment at the end of the month March 29, 2024, and that C1 would ask facility to take C1 to urgent care if C1 feels it is necessary. C1 was taken to C1 dental appointment on March 29, 2024 as scheduled and was recommended sensodyne toothpaste once again and C1 had it available at time of visit. In regards to house manager giggling due to C1 slipping from wheelchair. S1 stated there is no house manager and that S1 did not witness anyone giggling. There is not enough evidence to substantiate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Administrator Karen Gazon and copy of report provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2024

LIC9099 (FAS) - (06/04)

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