198601495-1-22-2023-11-AS-MVAO-CNDSXG-20230124131556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601495
Report Date: 12/01/2022
Date Signed: 01/22/2023 07:08:34 AM

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
08/03/2022 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20220803115230

FACILITY NAME:	HOME 2 U 4		FACILITY NUMBER:	198601495
ADMINISTRATOR:	GWENDOLYN COLE		FACILITY TYPE:	735
ADDRESS:	9140 S. HOBART BLVD		TELEPHONE:	(310) 702-9572
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY:	4	CENSUS: 3	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Stacey Diaz		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Client sustained bruises while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on, Thursday, December 01, 2022. 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 staff Stacey Diaz and spoke to Licensee Keith Cole via telephone. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: LPA Bunker interviewed two staff 1-2 (S1-S2) and clients 2-4 (C2-C4) all stated client did not sustained bruises while in care and the staff is providing all the clients with the necessary care and supervision. LPA Bunker toured the entire buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. LPA Bunker requested and reviewed C1's records. LPA Bunker requested copies of supporting documents. Licensee Keith Cole provided LPA Bunker with copies of the client's records. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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 11-AS-20220803115230

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: HOME 2 U 4	FACILITY NUMBER: 198601495
	VISIT DATE: 12/01/2022

NARRATIVE

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Continued LIC9099-C page 2

Allegation #1: Resident sustained bruises while in care
On 08/09/2022 and 12/01/2022, staff 1-2 (S1-S2) a total of three (3) staff were interviewed during the course of the investigation. Clients 2-4 (C2-C4) were also interviewed and stated the allegations is false. Staff 1-3 and C2-C4 stated client 1 (C1) did not sustain any bruises while in care. C2-C4 stated they were happy living here. Staff 1-3 and C2-C4 all denied the allegation.

Investigation revealed the following: Staff 1-3 (S1-S3) and clients 2-4 (C2-C4) interviewed stated the allegation is false. C2-C4 stated staff does not abuse clients. On 08/09/2022 and 12/01/2022, LPA Bunker contacted a health and safety check and toured the facility. LPA Bunker did not observe any signs of neglect or physical abuse. S1-S3 stated C1's mother told staff her son is coming to stay with her. The mother had the Los Angeles County Sheriff's Department come to the facility so that she could take her son to live with her. Mr. Cole stated the mother had some old documents that weren't valid that she showed to the Sheriffs and they believed her. Mr. Cole stated C1 was court-ordered to be at the facility. Mr. Cole stated C1's sister is his legal conservator, not the mother. Mr. Cole stated staff had been taking C1 to supervisory visits with the mother. The Sheriffs stated the facility had to let the son go with the mother. S1- S3 stated the mother is on drugs and is homeless. The mother had C1 living homeless on the streets with her. Mr. Cole stated the mother told him the hospital put bruises on her son. Mr. Cole stated the emergency room doctors at Kaiser Permanente Downey called and said he was in the hospital. Mr. Cole stated C1 never sustained bruises in their care. Licensee Keith Cole stated he was unaware of the complaint allegation. On 08/03/2022, South Central Los Angeles Regional Center (SCLARC) Quality Assurance (QA) representative contacted him via telephone and reported an alleged abuse against client 1 (C1). Mr. Cole stated on 08/03/202, he immediately self-reported the allegation to Community Care Licensing and all the appropriate agencies in a timely manner, prior to the complaint. Mr. Cole stated on 08/04/2022 at 10:00 A.M., SCLARC QA representative came to the facility and interviewed C1 and staff, Stacey Diaz. QA representative observed C1's upper torso there was no visible bruising. Mr. Cole stated the police came out and did not observe any bruises on C1 they did not leave a police report. S1-S3 and C2-C4 all denied the allegation.
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: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

LIC9099 (FAS) - (06/04)

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