198601304-5-23-2023-28-AS-TVAO-CSUTTG-20230616150044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601304
Report Date: 05/23/2023
Date Signed: 05/23/2023 01:38:50 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
05/18/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230518112119

FACILITY NAME:	BAILEY CARE HOME #4		FACILITY NUMBER:	198601304
ADMINISTRATOR:	SHAWN L. BAILEY		FACILITY TYPE:	735
ADDRESS:	10413 VULTEE AVE.		TELEPHONE:	(562) 622-0806
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	4	CENSUS: 3	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Blanca Samoya (S-1) and Mary George (S-2)		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff are not ensuring that client is adequately fed.
Facility staff verbally abused client.
Facility staff threw water at client.
Facility staff had altercations with client.
Facility staff physically abused client.
Facility staff did not meet client's diapering needs.
Facility staff did not ensure that client was adequately clothed.
Facility staff did not ensure that client had adequate bedding.
Facility staff did not meet client's hygiene needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial visit to investigate the above allegations. LPA was allowed entry by Blanca Samoya (S-1). LPA met with Mary George (S-2) and discussed the purpose of today's visit.

During this investigation, LPA obtained a copy of the staff roster, client roster, interviewed Staff #1 (S-1) through Staff #4 (S-4) and reviewed file for Client #3 (C-3) and obtained revelant documentation. LPA also interviewed C-3's Service Coordinator (SC) from South Central Regional Center. LPA was unable to interview Cient #1 (C-1) and Client #2 (C-2) as both are non-verbal. C-3 was uncooperative for an interview. Per interviews conducted, C-3 has a history of fabricating stories.

Refer to LIC 9099C for the continuiation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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 28-AS-20230518112119

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: BAILEY CARE HOME #4	FACILITY NUMBER: 198601304
	VISIT DATE: 05/23/2023

NARRATIVE

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Allegation: Facility staff are not ensuring that client is adequately fed. Staff interviews revealed that clients are adequately fed. Per Staff interviews, clients are provided with (3) meals and (2) snacks daily. Per Staff interviews, C-3 often refuses to eat the meals and snacks offered and tends to eat “a lot of junk food”. (1) out of (4) interviewed staff indicated C-3 often requests to eat “crab and lobster”. Interviewed staff indicated that at times C-3 throws the food towards staff. (1) out of (3) clients indicated that staff do not ensure that clients are adequately fed. Interviews do not corroborate this allegation.

Allegation: Facility staff verbally abused client. Staff interviews revealed that staff do not verbally abuse clients. Staff interviews revealed that C-3 becomes verbally abusive towards staff. Per Staff interviews, they have not witnessed nor received any concerns/complaints in regards to staff verbally abusing clients (including threatening, harassing or name calling). Per Staff interviews, staff are trained in mandated reporting, client rights and zero tolerance. (1) out of (3) clients indicated that staff verbally abuse clients.Interviews do not corroborate this allegation.

Allegation: Facility staff threw water at client. Staff interviews revealed that staff do not throw water at clients. Per staff interviews, C-3 has thrown water at staff. Per Staff interviews, they have not witnessed nor received any concerns/complaints in regards to staff throwing water at clients. Per Staff interviews, staff are trained in mandated reporting, client rights and zero tolerance. (1) out of (3) clients indicated that staff throw water at the client. Interviews do not corroborate this allegation. Interviews do not corroborate this allegation.

Allegation: Facility staff had altercations with client. Interviewed staff indicated C-3 often has altercations with staff (throws food at staff, attempts to hit staff, threatens staff, uses profanity towards staff). Per staff interviews, staff attempt to redirect C-3 when this occurs. Interviewed staff indicated staff enter notes when this occurs. (1) out of (3) clients indicated staff have altercations with the client. Interviews do not corroborate this allegation.

Allegation: Facility staff physically abused client. Interviewed staff indicated staff do not physically abuse clients (including shoving). Per staff interviews, C-3 has attempted to hit staff. Per Staff interviews, they have not witnessed nor received any concerns/complaints in regards to staff physically abusing clients. Per Staff interviews, staff are trained in mandated reporting, client rights and zero tolerance. (1) out of (3) clients indicated that staff physically abuse client. Interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230518112119

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: BAILEY CARE HOME #4	FACILITY NUMBER: 198601304
	VISIT DATE: 05/23/2023

NARRATIVE

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Allegation: Facility staff did not meet client's diapering needs. Interviewed staff indicated staff meet client’s diapering needs. Per staff interviews, (2) out of (3) clients complete to their bathroom needs independently, however, they wear incontinence briefs as a precautionary measure. Per staff interviews, (1) out of (3) clients wears diapers and informs staff when they need a change of diaper or assistance (at times this client does not allow staff to change their diaper). Per staff interviews, clients are not left “soaked”. (1) out of (3) clients indicated staff do not meet client’s diapering needs. Interviews do not corroborate this allegation.

Allegation: Facility staff did not ensure that client was adequately clothed. Interviewed staff indicated staff ensure that clients are adequately clothed. Per staff interviews, clients are not left with just wearing a diaper without any clothes, blankets or pillows or left with a t-shirt without a diaper. (1) out of (3) clients indicated staff do not ensure that the client is adequately clothed. Interviews do not corroborate this allegation.

Allegation: Facility staff did not ensure that client had adequate bedding. Interviewed staff indicated clients are provided with adequate bedding. Interviewed staff indicated that clients from this facility were taken to a trip on 05/14/23 which included an overnight stay. Per staff interviews, C-3 was provided a lower bed to facilitate transfers. Per staff interviews, there was no altercation nor any shoving between C-3 and S-2. (1) out of (3) clients indicated facility staff did not ensure that the client had adequate bedding. Interviews do not corroborate this allegation.

Allegation: Facility staff did not meet client's hygiene needs. Interviewed staff indicated staff meet clients’ hygiene needs. Staff interviews revealed that C-3 often refuses assistance with hygiene (including bathing and transferring to wheelchair) and with diaper changes. (1) out of (3) clients indicated staff do not meet client’s hygiene needs. Interviews do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Mary George

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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