198600581-5-2-2025-28-AS-WSHO-DGHL53-20250509082629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600581
Report Date: 05/02/2025
Date Signed: 05/02/2025 04:57:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/25/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250425151802

FACILITY NAME:	HOMES FOR LIFE FOUNDATION-HFL CEDAR STREET HOME		FACILITY NUMBER:	198600581
ADMINISTRATOR:	VIDA ANDRADE		FACILITY TYPE:	735
ADDRESS:	11401 BLOOMFIELD, BLDG.305-307		TELEPHONE:	(562) 207-9660
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	38	CENSUS: 32	DATE:	05/02/2025
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Vida Andrade,Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not dispense medications in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Nune Margaryan and Blanca Gonzalez conducted an unannounced initial 10-Day complaint investigation regarding the above allegation. LPAs meet with Administrator Vida Andrade who assisted with the visit. The purpose of the visit was explained.

The investigation consisted of the following: LPAs obtained copies of Staff & Clients Rosters, Staff schedule, Protocol on Medication Refusal and Missed Medications, Right to refuse medication,
Reviewed C1's file and obtained copies of Admission Agreement, Face sheet/ emergency information, Physicians Report, Sign in / Sign out sheet,MARs for March, April and May 2025, Doctor's order, Preplacement Appraisal, Functional Capability Assessment, SIRs about C1's refusal of medications. Administrator, Staff 1(S1) - Staff 3(S3), Client 1 (C1) - Client 5(C5) were interviewed. C1 was out of facility and interviewed over the phone.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

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-20250425151802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HOMES FOR LIFE FOUNDATION-HFL CEDAR STREET HOME	FACILITY NUMBER: 198600581
	VISIT DATE: 05/02/2025

NARRATIVE

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The investigation revealed the following: In regard to the allegation: Staff do not dispense medications in a timely manner. It was alleged that C1 miss their medication due to staff not dispensing them if C1 is not in their room.

Staff interviews revealed that medications are dispense as prescribed and are provided to C1 and other clients timely on a routine basis and are documented in the Medication Administration Record (MAR). Interviewed staff indicated that C1 often will go out in the community without informing staff and will return to request their medication. Also often C1 refuse to take the medications. (SIRs were provided to LPAs). Interviewed staff stated facility has a one-hour window on each side of hour C1 doctor has ordered to dispense C1 medication and it will be medication error if they will administrate prescribed medications to C1 the way how is C1 is requesting. Staff stated they encouraged C1 and other clients to take their medication, but staff will not administrate medication out of the window that client’s doctor has ordered. LPAs reviewed the MARs for the months of March, April and May 2025 and observed that C1 often missed their medications because was out of the facility or refused. LPAs reviewed documentation on the back of Medication Record which confirm what staff said and which days C1 refused or missed the medications. Interviewed C1 retracted their statement. C1 stated that they do not have any complaints about this matter. Interviewed C2-C5 indicated staff provide their medication as ordered by their doctor and is given on a timely and consisted manner. Interviewed Clients indicated they do not have any concerns about the staff administrating their medication and do not have any concerns regarding this matter.

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.

Exit interview was conducted and the copy of this report was provided to the Administrator Vida Andrade.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2025

LIC9099 (FAS) - (06/04)

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