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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601574
Report Date: 04/20/2023
Date Signed: 04/20/2023 03:18:55 PM

Document Has Been Signed on 04/20/2023 03:18 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:CARTAGENA HOMEFACILITY NUMBER:
198601574
ADMINISTRATOR:PEARL LAMBFACILITY TYPE:
735
ADDRESS:1306 CARTAGENA STREETTELEPHONE:
(562) 988-8142
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY: 4CENSUS: 4DATE:
04/20/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:ADMINISTRATOR CRISTINA SERAFICOTIME COMPLETED:
03:30 PM
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On 04/20/2023 around 11:00am Licensing Program Analyst (LPA) Jose Calderon initiated an unannounced Case Management visit – Other the above said facility Cartagena Home. Today’s visit was conducted face to face with administrator S1 due to complaint 11-AS-20230223084511.

On 04/20/2023 LPA Calderon requested 6 months of bank statements for each of 4 residents. LPA Calderon requested 6 months of P&I ledger information for each resident. LPA Calderon requested 6 months of cash receipts for purchases for each resident. On 04/20/2023 LPA Calderon interviewed S1-S3 for case management visit. S1 states that all resident’s money comes from regional center. S1 states that regional center deposited directly into resident’s bank accounts. S1 states that all residents have US bank account. S1 states that prior to incident multiple people has access to online account. S1 states that the only time accounts are accessed is when cash is needed. S1 states that staff will request cash amount and only administrator will obtain money from resident’s account. S1 states that all cash purchases have a receipt associated to the account. S1 states that if all requested money is not spending all cash balance is kept in each resident lock box. S1 states that administrator prints out at the beginning of the month bank statement and end of the month bank statement for each resident to make sure the P & I ledger balances out. S1 states that prior to the incident no internal audit was done by management to make sure receipts were accurate and in line with purchase cost. S1 states that the max amount of cash on hand for each resident is $200.00. S2 states that S2 would take R1 and R2 to super cuts for haircuts and the maximum cost was $35.00 dollars. S2 states that the last time R3 last time R3 went to a salon was June or July 2022. S2 states that other staff member told S2 that resident R1 had no money in R1 account. S2 states that R3 had 1500.00 deposited into
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 04/20/2023
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R3 account and management had $1500.00 cash on hand and when S2 wanted to purchase clothes for R3 they were told no money could be found. S2 states that the lock box for R3 was left unlocked and LPA Scott requested a copy and the $1500.00 was not noted, then after the audit the money was entered in the ledger. S3 states that administrator would give them money requested and they would provide a receipt for the purchases. S3 states that S3 is aware of the R3 that had $1500.00 per month. S3 states that the resident needed clothes and S3 were told that resident had no money in R3 account. S3 states that resident use super cuts for the hair needs and have never used a salon and the supposed purchase of $290.00 X 2 dollars are not in line as resident use Supercuts for the hair needs and the total cost for a haircut is $25 to $35 dollars. S3 states that resident was purchased Michael Kor backpack for $500.00 each and this is not in line.

An exit interview was conducted with administrator S1, and a hard copy was provided by hand for signature.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/20/2023 03:18 PM - It Cannot Be Edited


Created By: Jose Calderon On 04/20/2023 at 02:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CARTAGENA HOME
FACILITY NUMBER: 198601574

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited
CCR
85072(b)(7)

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85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights.(7) To possess and control his/her own cash resources.This requirement is not met as evidence by:
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LIcensee to provide 6 months of band statements for LPA Calderon review. Licensee to train mamagment to audit P&I ledger and cash receipts. Licensee to provide training and bank statement by 04/28/2023 by email to LPA Calderon
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Based on LPA's observation, review of records and interviews conducted the licensee did not audit the P&I for cash purchases for residnets. This poses a potential Health & Safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Eva M Alvarez
LICENSING EVALUATOR NAME:Jose Calderon
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2023


LIC809 (FAS) - (06/04)
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