198600723-5-16-2024-11-AS-MVAO-D5QR7B-20240529124603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600723
Report Date: 05/16/2024
Date Signed: 05/16/2024 01:12:06 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2024 and conducted by Evaluator Sparkle Day

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240429140403

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:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	David Vaughn		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff Do Not allow clients to leave facility
Staff are not allowing clients to use the phone
Client sustained an unexplained injury while in care

INVESTIGATION FINDINGS:

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On 5/16/24 at 12:30 pm, Licensing Program Analyst (LPA) Sparkle Day conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with David Vaughn (Administrator) who allowed entry into the facility and assisted with the visit.
The investigation consisted of the following: On 5/8/24 LPA Day obtained copies of the facility's roster for residents and staff. Review of resident #1 (R#1) file, including Physicians Report Admission Agreement , IPP--Appraisal/Needs . LPA interviewed R#2 and R#3 (A1) Administrator, David Vaughn and Staff #1 LPA interviewed witness # 1and #2 (W1-W2) via phone.
The investigation consisted of the following:
Allegation: Staff do not allow clients to leave facility.
It is alleged facility staff locked the facility and would not allow a client to leave. On 5/8/24 at around 9:30am LPA interviewed the Administrator regarding the allegation, Administrator denied the allegation and stated all clients are able to leave the facility when they want.On 5/8/24 between 9:30am and 2:00pm LPA interviewed

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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 11-AS-20240429140403

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VAUGHN LIVING SERVICES	FACILITY NUMBER: 198600723
	VISIT DATE: 05/16/2024

NARRATIVE

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2 of 3 clients and 2 of the 3 clients denied the allegation. On 5/8/24, around 10:00am LPA interviewed staff #1 regarding the allegation. 1 of 1 staff interviewed denied the allegation. On 5/8/23, LPA interviewed Witness #1-2 and 2 of 2 witnesses were consistent in their statements that the clients are allowed to come and leave the facility as they choose. On 5/8/24 during the visit LPA also observed a sign in and out sheet for clients when they leave and return from the facility, that showed the daily coming and going of the clients.

Based upon this investigation, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding Allegation-Staff are not allowing clients to use the phone.

It is alleged when clients ask to use the phone facility staff are refusing the clients form using the phone. On 5/8/24 at around 10:00am LPA interviewed the Administrator regarding the allegation, Administrator denied the allegation and stated clients are able to use the phone when requested. On 5/8/24 between 9:30am- 2:00pm LPA interviewed 2 of the 3 clients who denied the allegation. On 5/8/24 around 10:00am LPA interviewed staff #1 regarding the allegation. 1 of 1 staff interviewed denied the allegation. On 5/8/24, LPA interviewed Witness #1-2 and 2 of 2 witnesses were consistent in their statements that the clients are allowed to use the phone when requested. On 5/8/24, LPA verified the facility has a working phone for client use.

Regarding Allegation-Client sustained an unexplained injury while in care.

On 5/8/24 between 9:30am-2:00pm LPA interviewed 2 of 3 clients and 2 of the 3 clients denied the allegation. On 5/8/24, around 10:00am LPA interviewed staff #1 regarding the allegation. 1 of 1 staff interviewed denied the allegation. On 5/8/23, LPA interviewed Witness #1-2 and 2 of 2 witnesses were consistent in their statements that client #1 never informed them or mentioned any injury to them. On 5/16/24 LPA interviewed client #1 who stated he injured himself while shaving and did not tell anyone at the facility.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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