198600581-12-9-2022-28-AS-TVAO-CP4URH-20230216144846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600581
Report Date: 12/09/2022
Date Signed: 12/09/2022 01:45:50 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
11/30/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221130123025

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: 30	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Mark Ortega, Staff		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not prevent client from losing excessive weight.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced complaint investigation regarding the above allegation. LPA met with Staff, Mark Ortega, and explained the reason for the visit. The facility manager, Nicholas Novella, and the Administrator, Vida Andrade, arrived shortly after to assist with the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Client Rosters, reviewed Client #1’s (C1) file and obtained copies of documents. LPA interviewed the Administrator, 4 Staff, and 3 Clients. LPA attempted to interview C1 but was not successful.

The investigation revealed the following:
In regards to the allegation - " Staff did not prevent client from losing excessive weight", it is alleged that Client #1 (C1) was starting to lose weight back in September and by October, C1 loss 20 lbs. The staff did not do anything about client not eating and losing weight.
(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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-20221130123025

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: HOMES FOR LIFE FOUNDATION-HFL CEDAR STREET HOME	FACILITY NUMBER: 198600581
	VISIT DATE: 12/09/2022

NARRATIVE

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The Administrator indicated she was aware of C1 not eating much and losing weight. She stated that she along with staff tried to encourage C1 to eat more and offered different types of food. She indicated that the physician, psychiatrist, and C1's conservator were made aware of this issue. She had tried reaching out to the Psychiatric Mobile Response Team for consultation but C1 did not qualify due to client was not gravely disabled. LPA reviewed the physician’s progress report and the weight for C1’s was tracked each month. Staff interviewed also acknowledged that C1 ate very little and encouraged C1 to eat more and offered choices. Staff also stated they monitor clients during their meals and would check the meal monitoring form when clients come to the dining room to eat. LPA reviewed the daily meal monitoring forms for the month of September and C1 appeared to have come out for meals majority of the time in September. Per staff, although C1 came for meals in the dining room, C1 ate very little. One of the staff expressed the concern to C1’s conservator about the eating pattern and was requested for the conservator to speak to C1 about eating. LPA interviewed 3 clients. One of the clients also noticed that C1 was getting skinnier but stated C1 ate. All 3 indicated that staff are attentive and monitor them daily. Although C1 did lose weight while in care, LPA did not find there was negligence coming from the staff.

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 was held. A copy of this report and appeal rights were provided to the Administrator.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC9099 (FAS) - (06/04)

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