198601623-4-8-2024-11-AS-SCIS-D5HQQD-20240522122210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601623
Report Date: 04/08/2024
Date Signed: 04/08/2024 08:54:15 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20240322111923

FACILITY NAME:	PATE ENTERPRISES, INC. ( MENLO )		FACILITY NUMBER:	198601623
ADMINISTRATOR:	WESLEY PATE, JR.		FACILITY TYPE:	735
ADDRESS:	14801 GRAMERCY PLACE		TELEPHONE:	(213) 725-4634
CITY:	GARDENA	STATE: CA	ZIP CODE:	90249
CAPACITY:	6	CENSUS: 4	DATE:	04/08/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Renita Campbell, Assistant Administrator		TIME COMPLETED:	08:46 AM

ALLEGATION(S):

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Staff pushed a resident causing them to fight another resident.
Resident was injured by another resident.

INVESTIGATION FINDINGS:

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On 4/08/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA arrived and spoke to Assistant Administrator, Renita Campbell and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following: On 3/28/24 LPA toured the facility and reviewed both Staff and Residents files. LPA requested and reviewed copies of the following records: Physician’s Report, Id form, Appraisal Needs and Services, Staff roster, Staff schedule, DSP letters, CPI, CPR, and staff training.

The investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

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 11-AS-20240322111923

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: PATE ENTERPRISES, INC. ( MENLO )	FACILITY NUMBER: 198601623
	VISIT DATE: 04/08/2024

NARRATIVE

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Allegation: Staff pushed a resident causing them to fight another resident

It is being alleged that a staff member pushed resident causing them to fight each other. During file review, LPA first observed the roster and all employees cleared. LPA did not observe S1 at the facility. LPA observed the schedule of staff for this facility. LPA observed that S1 is on the schedule but was taken off duty on 3/20/24, the day of said incident and has not been working since. S1 is presently not scheduled to work pending this investigation.

On 3/28/24, LPA Shirley interviewed staff 1 through staff 4(S1-S4). LPA asked staff, are you aware of an incident regarding staff pushing a resident causing them to fight another resident. Of those interviewed, 1 stated, yes, they were informed by Regional about allegation. The remaining 3 stated that they were not aware. LPA Shirley interviewed client 1 – client 4 (C1-C4). LPA ask clients if they had seen a staff member push a resident causing them to fight another resident. Of those interviewed, 2 out of 4 answered no. 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 allegations are Unsubstantiated.

Based on information gathered, the department did not find sufficient evidence to support allegations "Staff pushed a resident causing them to fight another resident.”

Allegation: Resident was injured by another resident

It is being reported that a resident was injured by another resident. On 3/28/24, LPA Shirley toured the facility and found no present or imminent threat to the health and/or safety of the residents in care. LPA Shirley reviewed staff, client and facility files. During file review, LPA found that there were no reports of violence or misconduct to clients by this staff.

On 3/28/24, LPA Shirley interviewed staff 1 through staff 4(S1-S4). LPA asked staff, are you aware that a resident was injured by another resident. Of those interviewed, 2 out of 4 answered no. LPA Shirley interviewed client 1 – client 4 (C1-C4). LPA ask clients do you know if a resident was injured by another resident and of those interviewed, 2 out of 4 answered no. 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 allegations are Unsubstantiated.

Based on information gathered, the department did not find sufficient evidence to support allegations "Resident was injured by another resident.”

An exit interview was conducted and a copy of the LIC 9099 was provided to Assistant, Administrator Renita Campbell.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2024

LIC9099 (FAS) - (06/04)

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