198600723-4-17-2023-11-AS-SCIS-CUHRVC-20230808132118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600723
Report Date: 04/14/2023
Date Signed: 04/17/2023 02:43:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230407092447

FACILITY NAME:	VAUGHN LIVING SERVICES		FACILITY NUMBER:	198600723
ADMINISTRATOR:	VAUGHN SR., DAVID		FACILITY TYPE:	735
ADDRESS:	2516 WEST 80TH STREET		TELEPHONE:	(323) 752-5226
CITY:	INGLEWOOD	STATE: CA	ZIP CODE:	90305
CAPACITY:	4	CENSUS: 3	DATE:	04/14/2023
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	David Vaughn		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Facility in disrepair.
Residents not providing adequate food service.
Facility is malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Friday, April 14, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Licensee David Vaughn. LPA Bunker explained the purpose of today's visit.
LPA Bunker interviewed staff 1-2 (S1-S2) and clients 1-3 (C1-C3). LPA Bunker asked questions relevant to the nature of the complaint. S1 S2 and C1-C3 stated the facility is not in disrepair. Mr. Vaughn and LPA Bunker toured the facility. We observed an ample supply of perishable and non-perishable foods. S1-S2 and C1-C3 stated clients are served three (3) meals per day plus snacks. S1-S2 and C1-C3 stated clients get plenty of adequate food to eat. S1-S2 and C1-C3 stated when clients come home from their Day Program clients are served hot meals seven days a week from Sunday-Saturday. During the tour of the home, the facility did not have a malodorous smell. S1-S2 and C1-C3 state the facility does not have an unpleasant smell. LPA Bunker requested copies of supporting documents.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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-20230407092447

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VAUGHN LIVING SERVICES	FACILITY NUMBER: 198600723
	VISIT DATE: 04/14/2023

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: The facility is in disrepair.
Staff 1-2 (S1-S2) and clients C1-C3 (C1-C3) stated the sinks in the home were not leaking for months, and the facility is not in disrepair and needs to be repaired. S1-S2 and C1-C3 denied the allegation.

Allegation #2: Residents not providing adequate food service.
Staff 1-S2 (S1-S2) and clients 1-3 (C1-C3) stated clients are provided with adequate food service. S1-S2 and C1-C3 stated that the clients are getting plenty of food to eat, three (3) meals per day plus snacks, breakfast, lunch, dinner, and snacks daily. S1-S2 and C1-C3 denied the allegation.

Allegation #3: The facility is malodorous.
Staff 1-2 (S1-S2) and clients 1-3 (C1-C3) stated the facility does not have a gas leak or reeks of a gas smell. S1-S2 and C1-C3 stated the facility does not have a malodorous smell. S1-S2 and C1-C3 denied the allegation.

Investigation revealed the following: Staff 1-2 (S1-S2) and clients 1-3 (C1-C3) interviewed stated the allegations are all false. Mr. Vaughn and LPA Bunker toured the facility building and grounds. S1 S2 and C1-C3 stated the facility is not in disrepair. S1-S3 and C1-C3 stated the sinks in the home were not leaking for months. During the visit, we did not observe any water leaks from the sinks, and none of the windows in the home were broken. The windows were in operable condition. S1-S2 and C1-C3 stated clients are not served only cereal for breakfast, a bologna sandwich for lunch, and hamburger helpers for dinner every day. LPA Bunker observed an ample supply of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. The facility had plenty of in the refrigerator and kitchen cabinets meat, chicken, beef, ground turkey, pork chops, fish, salmon, beef patties, frozen b.b.q. ribs boneless rib-shaped patties, smoked sausage links, bacon, frozen burritos, frozen beef taquitos, frozen vegetables, lunch meat, cold cuts, pizza, eggs, butter, yogurt, milk, cream, cheese, dip, salad dressing, ketchup, mustard, beans, peas, canned vegetables, fruit cups, peanut butter, bread, cereals, grits, oatmeal, rice, noodles, macaroni, pasta, potato, grain, hamburger helps, breakfast bars, crackers, nuts, chips, cookies, raisins, canned food, fresh fruits, tomatoes, avocados, oranges, strawberries, and bananas, fresh vegetables, bell pepper, onions, lettuce, sweet peppers, and sweet corn, desserts, coffee, water, apple, orange, and fruit juice, etc. See continued LIC9099-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230407092447

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VAUGHN LIVING SERVICES	FACILITY NUMBER: 198600723
	VISIT DATE: 04/14/2023

NARRATIVE

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Continued LIC812-C page 3

S1-S2 and C1-C3 stated clients are served three (3) meals per day plus snacks. S1-S2 and C1-C3 stated clients get plenty of adequate food to eat. S1-S2 and C1-C3 stated clients are served hot and cold meals seven days a week from Sunday-Saturday. S1-S2 and C1-C3 stated the facility did not have a malodorous smell. S1-S2 stated the facility does not reeks of gas and does not have a gas leak. Mr. Vaughn stated that however, the entire neighborhood has complained to the City of Inglewood about a foul odor on the block. Mr. Vaughn stated that the facility has no control over the unpleasant smell that sometimes comes from the street or the air. C1-C3 stated they were happy living here and had no problems. S1-S2 and C1-C3 interviewed denied any all allegations

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.

There were no deficiencies cited. Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC9099 (FAS) - (06/04)

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