198601513-8-7-2023-11-AS-MVAO-CVMS2A-20230913132913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601513
Report Date: 07/24/2023
Date Signed: 08/07/2023 08:58:27 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
07/14/2023 and conducted by Evaluator Lizeth Villegas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230714133430

FACILITY NAME:	OPEN ARMS ADULT RESIDENTIAL FACILITY, LLC		FACILITY NUMBER:	198601513
ADMINISTRATOR:	ROBBIE M. THOMPSON		FACILITY TYPE:	735
ADDRESS:	229 SOUTH LOCUST AVENUE		TELEPHONE:	(310) 346-3447
CITY:	COMPTON	STATE: CA	ZIP CODE:	90221
CAPACITY:	4	CENSUS: 4	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Robbie Thompson		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff physically assaulted resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 07/20/23 Licensing program analyst (LPA) Lizeth Villegas conducted a subsequent complaint visit to render investigation finding. LPA met with Administrator, Robbie Thompson as the purpose of today’s visit was explained.
The investigation consisted of the following: On 07/20/23 LPA interviewed Administrator Robbie Thompson (A1) and interviewed Staff #3-4 (S3-S4) and interviewed residents # 1-4 (R1-R4). LPA obtained copies of R1's file (face sheet, physicians report, medication list, physicians orders, Individual Program Plan ( IPP), needs and service plan and incident report.) LPA also obtained copies of the following from staff files (Staff schedule, 40-hour staff orientation plan, staff 35-hour direct support training, CPI training verification, zero tolerance of abuse policy-in service.) On 7/24/23, LPA interviewed Staff #1-2 (S1 & S2).
The investigation revealed the following: On 07/20/23 LPA interviewed Administrator Robbie Thompson regarding the above allegation, Administrator stated that on 7/10/23 R1 was experiencing a behavior episode and began to get verbally and physically aggressive towards

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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 2

Control Number 11-AS-20230714133430

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: OPEN ARMS ADULT RESIDENTIAL FACILITY, LLC	FACILITY NUMBER: 198601513
	VISIT DATE: 07/24/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

S1, per administrators own investigation S1 blocked R1 from making any physical contact and after some redirection R1 was able to calm down before being transported to day program.

On 7/20/23 & 7/24/23 LPA interviewed S2-S4 who denied the above allegations, Per S1, S1, S1 and S4, R1 is a self-injurious and has had behavior episodes but is usually redirect able after some time and verbal interventions.

On 7/20/23 LPA interviewed R1, when asked about the above allegations R1 stated he gets upset and starts hitting. LPA asked R1 if any staff has physically abused R1, R1 stated he does not know while shaking his head yes. R1 later stated he defends himself then proceeds to show LPA a light green/yellowish 4-inch bruise on the left side of his chest, when asked how he obtained the bruise R1 reported that he does not remember.

On 7/20/23 LPA attempted to interview R2-4 but was unable to do so as R2-4 are nonverbal and their were not alternate ways of communicating the residents.

On 7/20/23, LPA conducted a review of R1 filed which revealed the following: Behavior Plan date (10/01/22 indicated R1 behavior include R1 behavior include non-compliance, disruptive behavior, emotional outburst, physical aggression, hallucinations and fabrications. According to the behavior plan, facility staff are to deescalate R1 behaviors by stopping and actively listen to what R1 is trying to express by his behavior. Try to find out what he wants or needs from his environment. Emphasize the importance of his talking in an indoor voice so you can hear him.

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 unsubstantiated.

Exit interview conducted to Administrator Robbie Thompson and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2