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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600496
Report Date: 08/05/2024
Date Signed: 08/05/2024 04:02:52 PM

Substantiated


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
07/26/2024 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240726075240
FACILITY NAME:SKY HOMESFACILITY NUMBER:
198600496
ADMINISTRATOR:SMITH, SHIRRELLFACILITY TYPE:
735
ADDRESS:6338 SOUTH STREETTELEPHONE:
(562) 455-5515
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:4CENSUS: 3DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Andrew Thomas (Lead Staff)TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff did not clean clients' bed that had feces and urine.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Andrew Thomas (Lead Staff) and explained the reason for the visit. Administrator Shirrell Smith showed up to the facility a few hours after.

The investigation consisted of the following: LPA Mora interviewed Administrator, Staff 1 - Staff 5 (S1 - S5), Client 1 - Client 3 (C1 - C3), and attempted to reach Regional Center Representative.

The investigation revealed the following: regarding the allegation "facility staff did not clean clients' bed that had feces and urine", it is alleged that there was a puddle of urine on C1's bedsheets and smeared feces on C2's bedsheet.

(Continued to LIC 9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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 6
Control Number 28-AS-20240726075240
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: SKY HOMES
FACILITY NUMBER: 198600496
VISIT DATE: 08/05/2024
NARRATIVE
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Administrator stated that on 07/25/2024 in the morning she received a call from a morning staff (S2) that had just clocked in (8:10am) and this staff reported that there was a puddle of urine on C1's bed and smeared feces on C2's bed. Administrator called the NOC shift staff (S3) and S3 told the Administrator that everything was good when S3 ended the shift. S3 stated that he/she did change C1's bedsheets and changed C1's clothes during his/her shift because C1 urinated on the bed and did another round and checked all clients and beds 15 minutes prior to being relieve by S1 and he/she did not see or smelled any urine or feces on the clients beds. S3 stated that around 7:30am S1 came to the facility and relieve S3, S3 told S1 that everything was good and that C1's bedsheets were replaced with new sheets. S3 also stated that clients were still in bed when his/her shift ended. S1 stated when he/she came in he/she did a body check on the clients in the living room and started working on some paperwork, but he/she did not see or smelled any feces or urine on the client's bed. S2 came in at 8:10am and that is when S2 discovered the clients' bed with the smeared feces and puddle of urine. Administrator stated that there was some conflict between her and S2 over the phone regarding this matter and S2 was asked to clock out, therefore, the Administrator came to the facility to resolve the issue.

Based on LPA's interviews, the preponderance of evidence standard has been met, therefore the allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099-D.

Exit interview held and a copy of the report and appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20240726075240
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: SKY HOMES
FACILITY NUMBER: 198600496
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2024
Section Cited
CCR
80065(a)
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Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs....

This requirement is not met by:
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Facility is to ensure that Title 22 Section 80065 regulations are met at all times. Additionally, an in-service training is to be conducted and a training log with staff signature submitted to CCLD by 08/12/2024.
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Based on interviews, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Facility staff failed to properly inspect the clients' bed to identify the feces and urine.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
07/26/2024 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240726075240

FACILITY NAME:SKY HOMESFACILITY NUMBER:
198600496
ADMINISTRATOR:SMITH, SHIRRELLFACILITY TYPE:
735
ADDRESS:6338 SOUTH STREETTELEPHONE:
(562) 455-5515
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:4CENSUS: 3DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Andrew Thomas (Lead Staff)TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff did not assist client in removing clothes covered in urine
Facility staff argued in front of the clients
Facility does not have sufficient food for the clients
Uncleared adult working at the facility
Facility does not maintain an adequate temperature in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Andrew Thomas (Lead Staff) and explained the reason for the visit. Administrator Shirrell Smith showed up to the facility a few hours after.

The investigation consisted of the following: LPA Mora interviewed Administrator, Staff 1 - Staff 5 (S1 - S5), Client 1 - Client 3 (C1 - C3), and attempted to reach Regional Center Representative.

The investigation revealed the following: regarding the allegation "facility staff did not assist client in removing clothes covered in urine", it is alleged that on the morning of 07/25/2024 C1 was covered in urine. Administrator stated that this was not reported to her and the only report she received was that C1's bedsheets had urine on it. S1 who did the body check on C1 that morning stated that C1 was dried and not covered with urine. Per staff interviews, they stated that C1 is always changed and clean at the start of their morning shift. C1 was unable to corroborate the allegation due to mental capacity. The two clients are non-verbal and couldn't provide information. (Continued to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20240726075240
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: SKY HOMES
FACILITY NUMBER: 198600496
VISIT DATE: 08/05/2024
NARRATIVE
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Regarding the allegation "facility staff argued in front of the clients", it is alleged that S1 was yelling at another staff in front of the clients. Administrator stated she was not at the facility during this incident and to her knowledge she does not know if there was yelling between the staff. S1 denied the allegation and stated he/she was not yelling at all. Per interviews with the other staff not involved in this incident, they stated that S1 has not screamed or yelled at other staff in front of the clients. Clients could not corroborate the allegation due to being non-verbal or not having the mental capacity to answer the questions.

Regarding the allegation "facility does not have sufficient food for the clients", it is alleged that the facility does not have enough food. Administrator and staff interviewed denied the allegation and stated there is enough food for the clients. Clients could not corroborate the allegation due to being non-verbal or not having the mental capacity to answer the questions. LPA Mora observed enough food for all 3 clients in the kitchen during this visit.

Regarding the allegation "uncleared adult working at the facility", it is alleged that S1 might not be cleared to be at the facility. Administrator stated that S1 has been cleared and associated to the facility since 2005. LPA Mora reviewed the Community Care Licensing Division (CCLD) Facility Personnel Report Summary on 07/25/2024 and observed that S1 has clearance and is associated to this facility.

Regarding the allegation "facility does not maintain an adequate temperature in the facility", it is alleged that
S1 instructs staff to turn off the AC because the electric bill will be to high. Administrator and S1 denied the allegation and stated that the facility is always kept at an adequate temperature and the AC is not turn off when it is needed. Staff interviewed denied the allegation and stated that S1 has not told them to turn off the AC. The AC is turned on whenever it is needed and when it is not then it is turned off. Clients could not corroborate the allegation due to being non-verbal or not having the mental capacity to answer the questions. During this visit, the facility was kept at an adequate temperature and the AC was turned on when it started to get hot and per the thermostat the temperature inside the facility was between 77 and 79 degrees F.

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.

Exit interview held and a copy of the report was provided
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6