198601112-6-20-2024-11-AS-EMAZ-D7XV72-20240808161021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601112
Report Date: 06/20/2024
Date Signed: 06/20/2024 03:45:21 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, 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
06/13/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20240613081231

FACILITY NAME:	HI HOPES, INC.		FACILITY NUMBER:	198601112
ADMINISTRATOR:	HAI NGUYEN		FACILITY TYPE:	735
ADDRESS:	2016 W 165TH ST		TELEPHONE:	(310) 532-2898
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	4	CENSUS: 4	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Hai Nguyen		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not ensure that residents' dietary needs are met
Staff do not ensure that the facility is operated within ratio requirement
Staff do not ensure that a record of residents' cash resources are maintained at the facility

INVESTIGATION FINDINGS:

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On 06/20/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced complaint visit to the facility listed above. LPA met with Director, Hai Nguyen, and Administrator, Suyono 'John' Wong, and the purpose of today’s visit was explained. During today’s visit there was one (1) Clients present at the facility.

During today’s visit, LPA toured the facility, interviewed Staff (S1-S4), interviewed Clients C1, and received and reviewed documents pertinent to the investigation. The documents received include the Staff Roster, Client Roster, P&I Ledgers and Money, Menu, Physician Reports, and Staff Schedule.

The investigation revealed the following:

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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 5

Control Number 11-AS-20240613081231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HI HOPES, INC.	FACILITY NUMBER: 198601112
	VISIT DATE: 06/20/2024

NARRATIVE

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Allegation: Staff do not ensure residents’ dietary needs are met
It is alleged clients are not served dairy foods, fruits, or vegetables. Additionally, it states clients are served rice and pasta meals and the facility runs out of food.
During facility tour, LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods. LPA observed a variety of fruits, vegetables, and dairy products. During record review, LPA reviewed the facility’s menu, and observed a variety of foods being offered to Clients. Additionally, LPA reviewed the Clients Physician’s Report and did not observe dietary orders for any of the clients. During today’s facility visit, LPA observed lunch being served to C1 which consisted of a sandwich, oranges, and apples served with a glass of milk and water.
During an interview with the Administrator (S1), was asked if clients receive a variety of foods including fruits, vegetables, and dairy products, S1 stated the clients are provided a variety of foods from all food groups.
During interviews with Staff (S2-S4), were asked if clients receive a variety of foods including fruits, vegetables, and dairy products, three (3) out of three (3) stated clients are served a variety of foods including fruits, vegetables, milk, cheese, and yogurt. Additionally, staff stated clients are able to go to the kitchen and have food when they want.
During interviews with Client (C1), was asked if they are served a variety of foods including fruits, vegetables, and dairy products, C1 answered yes.
During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.
Continued on LIC9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 11-AS-20240613081231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HI HOPES, INC.	FACILITY NUMBER: 198601112
	VISIT DATE: 06/20/2024

NARRATIVE

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Allegation: Staff do not ensure that the facility is operated within ratio requirement
It is alleged the facility is to provide one staff for every three residents and the facility has one staff providing care for four (4) residents.

During facility visit, LPA observed there was one (1) staff present and providing care to one (1) Client who currently does not attend day program. At 2:20pm, LPA observed a second staff arrive before the other three clients return form their Day Program. During record review, LPA observed there are two Direct Support Professionals scheduled to work between the hours of 7am through 10pm.

During an interview with the Administrator (S1), was asked what the ratio of staff is providing care to clients, S1 stated they keep a ratio of one (1) staff to two (2) clients.
During interviews with Staff (S2-S4), were asked how many staff are scheduled each shift, three (3) out of three (3) stated there are 2 staff working during each day shift while clients are present. Additionally, they stated on weekends there might be 1 staff due to two (2) of the clients usually go to their families for 2 to 3 nights.
During interviews with Clients (C1), were asked if they feel there are enough staff to meet the needs of, C1 answered yes.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Continued on LIC9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20240613081231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HI HOPES, INC.	FACILITY NUMBER: 198601112
	VISIT DATE: 06/20/2024

NARRATIVE

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Allegation: Staff do not ensure that a record of residents’ cash resource is maintained at the facility
It is alleged the licensee does not maintain the residents’ cash resources at the facility and there are no records maintained at the facility showing how their cash resources are handled or where their cash resources are maintained.

During the facility visit, LPA requested to review the P&I Ledgers, receipts, and monies for three (3) Clients. LPA observed the Ledgers and monies secured in a locked cabinet in the back living room. For the fourth client, their family takes care of their P&I Ledgers and monies. The facility does have copies of all the receipts from the Client’s purchases. During record review at the facility, LPA received and reviewed copies of the Clients P&I Ledgers, and reviewed the receipts, and the money. LPA did not observe any discrepancies in the records or the amounts of the ledgers, receipts, and monies.

During an interview with the Administrator (S1), was asked if the Client’s P&I Ledgers and monies are kept at the facility, S1 stated they are kept secured in a locked cabinet. Additionally, S1 stated there is one person at the main office who maintains the ledgers and balances them and when they are done the ledger’s, monies, and receipts are returned to the facility.
During interviews with Staff (S2-S4), were asked if clients P&I Ledgers and monies are kept at the facility, three (3) out of three (3) stated they are kept locked in the cabinet in a locked box.
During interviews with Clients (C1), were asked if they receive their P&I when requested, C1 answered yes.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20240613081231

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HI HOPES, INC.	FACILITY NUMBER: 198601112
	VISIT DATE: 06/20/2024

NARRATIVE

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During today's visit, LPA did not observe or cite any deficiencies.

An exit interview was conducted with Administrator, Suyono 'John' Wong, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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