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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601610
Report Date: 11/27/2024
Date Signed: 11/27/2024 04:16:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/27/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20241127105858
FACILITY NAME:FAMILY HANDS ADULT CARE FACILITYFACILITY NUMBER:
198601610
ADMINISTRATOR:TINA E. SCRUGGSFACILITY TYPE:
735
ADDRESS:10016 LA SALLE AVENUETELEPHONE:
(323) 533-2396
CITY:LOS ANGELESSTATE: CAZIP CODE:
90047
CAPACITY:4CENSUS: 3DATE:
11/27/2024
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Administrator - John TateTIME COMPLETED:
04:16 PM
ALLEGATION(S):
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Staff does not ensure that the facility remains free of odors.
INVESTIGATION FINDINGS:
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On 11/27/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced complaint visit at this facility. CCLD staff was greeted by Staff Fred Rodriguez.

The investigation consisted of the following:
On 11/27/2024, The department interviewed 3 staff, toured the facility, and reviewed Regional Center records dated 11/22/2024.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
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 4
Control Number 11-AS-20241127105858
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: FAMILY HANDS ADULT CARE FACILITY
FACILITY NUMBER: 198601610
VISIT DATE: 11/27/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Staff does not ensure that the facility remains free of odors”, it is being alleged that the facility has strong incontinence odors. CCLD staff toured the facility and smelled strong odors of incontinence. Observations and interviews conducted indicated that clients require incontinence care. The facility Administrator, John Tate acknowledged that the facility has incontinence odors. Regarding the allegation “Staff does not ensure that the facility remains free of odors", the preponderance of the evidence standard has been met therefore the allegation is substantiated.

Deficiencies cited based on observation and interviews conducted in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Administrator along with their appeal rights.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20241127105858
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FAMILY HANDS ADULT CARE FACILITY
FACILITY NUMBER: 198601610
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2024
Section Cited
CCR
80077.4(b)(4)
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Care for Clients with Incontinence (b) If a licensee accepts or retains a client who has bowel and/or bladder incontinence, the licensee is responsible for all of the following:...(4) Ensuring that clients with incontinence are kept clean and dry, and that the facility remains free of odors.
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 The Administrator has agreed to create a plan to keep facility free from incontinence odors. The administrator will email plan to Socorro.Leandro@dss.ca.gov. The department will conduct a POC visit to ensure the facility is free of incontinence odors.
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This regulation has not been met as evidence by: Based on observations and interviews conducted the licensee did not comply with the section above which poses a personal rights risk to clients in care. LPA smelled strong incontinence odors from the facility.
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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.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4