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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601529
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:45:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2021 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210108150022
FACILITY NAME:HIGHLAND PARK GUEST HOME, INC.FACILITY NUMBER:
198601529
ADMINISTRATOR:ROBERT S. IVES JRFACILITY TYPE:
735
ADDRESS:345 N. AVE 57TELEPHONE:
(323) 529-4267
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY:40CENSUS: 39DATE:
05/04/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Maria Lopez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility not adequately cleaning the facility.
Residents belonging not being safeguarded.
Facility does not have adequate toiletries.
Staff don’t speak English.
Facility not adequately staffed.
Facility phone not picked up in an adequate time.
INVESTIGATION FINDINGS:
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On 05/04/2022 at 11:00 a.m Licensing Program Analysts (LPAs) Joscelyn Martinez and Melissa Ruiz arrived at the facility to conduct a Subsequent Complaint Visit. LPAs arrived at the facility and meet with Assistant Administrator. The purpose of the visit was explained and the entrance interview was conducted.

On 01/14/2021 an initial 10-day visit was conducted but due to the situation surrounding Coronavirus Disease Further Investigation was needed.

Allegation #1 Facility not adequately cleaning the facility.
To investigate this allegation LPAs toured the facility at 11:50 a.m. LPAs observed housekeeping cleaning common areas during the tour. Staff were observed to be mopping floors, restocking bathroom toilet paper and towels, and discarding the trash. Additionally, staff interviews revealed that cleaning is conducted throughout the day by designated staff approximately 2-3 times a day. Based on interviews and observation this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
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 3
Control Number 31-AS-20210108150022
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HIGHLAND PARK GUEST HOME, INC.
FACILITY NUMBER: 198601529
VISIT DATE: 05/04/2022
NARRATIVE
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Allegation #2 Residents belongings not being safeguarded.

To investigate this allegation LPAs interviewed clients and staff. Six (6) out of seven (7) interviews with clients revealed that they do not have any issues with missing belongings. Interviews with staff stated they aware of one client who claims their items are missing but to the staff knowledge, this claim is not accurate. Based on interviews this allegation is deemed Unsubstantiated at this time.

Allegation #3

Facility does not have adequate toiletries.

To investigate this allegation LPAs toured the facility and interviewed clients. LPAs observed toilet paper, hand soap, and paper towels in bathrooms. LPAs observed a storage area where all the toiletries are stored. There is enough supply for more than 30 days. Interviews with (6) out of seven (7) revealed that clients have the choice of requesting toiletries from the facility or purchasing their own. Interviews with clients also revealed that if needed, toiletries such as razors, shampoo and soap are given when requested and in a timely manner. Based on observation and interviews this allegation is deemed Unsubstantiated at this time.

Allegation # 4 Staff don’t speak English

To investigate this allegation LPAs interviewed staff and clients. Interviews with Six (6) out of seven (7) clients revealed that clients do not have an issue communicating with staff, bilingual staff speak and understand English. Interviews with staff revealed that they are able to speak and understand English. Based on interviews this allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20210108150022
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HIGHLAND PARK GUEST HOME, INC.
FACILITY NUMBER: 198601529
VISIT DATE: 05/04/2022
NARRATIVE
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Allegation # 5 Facility not adequately staffed.

To investigate this allegation LPAs interviewed staff, clients, and collected relevant documents such as the LIC 500. Interviews revealed that there are approximately six (6) to seven (7) staff during the day. During today’s visit, six (6) staff were present at the facility. Facility is maintained open 24 hours and maintain a NOC shift. Interviews with six (6) out of seven (7) clients revealed when they request assistance from staff, there are no issues in staff responding in a timely manner. Based on interviews this allegation is deemed Unsubstantiated at this time.

Allegation #6 Facility phone not picked up in an adequate time.

To investigate this allegation LPAs conducted interviews with staff and clients. Interviews with two (2) staff revealed the facility has six phones located throughout the facility. Staff located inside the office are designated to answer the phone when it rings. After hours when the office is closed the staff will pick up the phone located in the kitchen area. Interviews with seven (7) out of seven (7) clients revealed they are able to use the landline if needed and have no issues with the facility phone. Based on interviews this allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. Report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3