198601529-11-9-2023-31-AS-EMIR-CYGTMP-20231213135128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601529
Report Date: 11/09/2023
Date Signed: 11/09/2023 01:59:03 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
11/03/2023 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20231103114548

FACILITY NAME:	HIGHLAND PARK GUEST HOME, INC.		FACILITY NUMBER:	198601529
ADMINISTRATOR:	ROBERT S. IVES JR		FACILITY TYPE:	735
ADDRESS:	345 N. AVE 57		TELEPHONE:	(323) 529-4267
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90042
CAPACITY:	40	CENSUS: 39	DATE:	11/09/2023
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Maria Lopez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff took resident's personal belongings.
Staff makes inappropriate comments towards resident.
Facility does not supply the bathroom with toilet paper and soap.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the house manager, Maria Lopez, and advised her of the complaint. Today's investigation consisted of interviews with the house manager, staff and residents, record review and a physical plant inspection.

Staff took resident's personal belongings:
In regards to the allegation, it was reported that Resident 1 (R1) was retaliated against for making a complaint, by entering their room when R1 was not present and taking their personal belongings such as dvds and clothing. Interview with the house manager denies the allegation, stating R1 locks the inside of their room at all times, never letting anyone in, even to clean. Staff would have to ask R1 permission to enter before coming in to clean. In addition, R1 is always present when staff enters to clean their room. Interview with R1 confirm their allegation of clothing and DVDs taken, but R1 could no specify the

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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 31-AS-20231103114548

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: 11/09/2023

NARRATIVE

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clothing and DVDs that were taken. R1 also could not identify or provide any witnesses to the allegation. Furthermore, R1 stated they declined to compete an inventory list of their personal belongings since being admitted. Interviews with three of three residents state staff treat them with respect, and has never reported any of their belongings missing. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff taking the resident's personal belongings. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff makes inappropriate comments towards resident:
In regards to the allegation, it was reported that R1 is getting verbally abused by staff. Interviews with the house manager and staff deny the allegation. They indicate it is R1 that gets verbally abusive towards them. R1 confirms the allegation of getting verbally abused and being called inappropriate names, but could not provide any witnesses, place, date and time to corroborate. Interviews with three of three residents state they've never been treated inappropriately by staff. Based on the information obtained, there was insufficient evidence to prove staff making inappropriate comments towards the resident. Therefore, the allegation is deemed Unsubstantiated at this time.

Facility does not supply the bathroom with toilet paper and soap:
In regards to the allegation, it was alleged that the bathrooms in the facility are not supplied with any toilet paper and soap. LPA conducted a physical plant inspection of the home. The facility has four bathrooms. Per plant inspection of all four bathrooms, LPA observed soap and toilet paper available for the residents use. LPA also checked facility storage and observed an adequate amount supply of soap and toilet paper. In addition, interviews made with three of three residents and no complaints were made about the bathrooms ever not having a supply of soap and toilet paper. Based on the information obtained, there was insufficient evidence to corroborate the allegation of facility not supplying the bathrooms with toilet paper and soap. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC9099 (FAS) - (06/04)

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