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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601623
Report Date: 06/05/2024
Date Signed: 06/05/2024 09:40:01 AM

Substantiated


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
11/08/2023 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20231108143305
FACILITY NAME:PATE ENTERPRISES, INC. ( MENLO )FACILITY NUMBER:
198601623
ADMINISTRATOR:WESLEY PATE, JR.FACILITY TYPE:
735
ADDRESS:14801 GRAMERCY PLACETELEPHONE:
(213) 725-4634
CITY:GARDENASTATE: CAZIP CODE:
90249
CAPACITY:6CENSUS: 4DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:Renita Campbell, Assistant AdministratorTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff grabbed resident in a manner that resulted in the resident sustaining bruises.
INVESTIGATION FINDINGS:
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On 6/5/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent visit to this facility. LPA was met by Renita Campbell, Assistant Administrator, and explained the purpose of the visit is to deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 11/9/23, LPA Shirley toured the facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. LPA requested and received copies of the following records: Staff Roster, Resident Rosters for the past 2 years, admissions agreements, identification and emergency information, physicians report, appraisal, medications. LPA also requested the following: doctor appointment 11/8/23, available pictures, incident reports for the last year, trainings on abuse, CPI and CPR cards, LIC 9182, LIC 508, Lic 9052. A separate investigation was conducted by Department of Social Services Investigations Bureau Investigator Heidy Bendana which consisted of interviews with clients and staff as well as a review of documentation.
Con'd on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
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 3
Control Number 11-AS-20231108143305
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: 06/05/2024
NARRATIVE
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The investigation revealed the following:


Allegation: Staff grabbed resident in a manner that resulted in the resident sustaining bruises.

Investigation Branch’s Department Investigator Heidy Bendana conducted interviews with staff from this facility, staff from Options for Life Day program, incident report from Gardena Police Department and reviewed medical records/reports. C1 reported to the staff at day program that S1 caused the bruises on their arm. Investigator Heidy Bendana interviewed staff from Pate Enterprises, during the investigation S1 stated they grabbed C1 to separate them from C2. The pictures Heidy Bendana received were confirmed to be of C1’s arm. S1 caused the bruises C1 sustained on their arm. Based on LPA’s observations interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the allegations of "Staff grabbed resident in a manner that resulted in the resident sustaining bruises” is found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

Deficiencies were issued for this allegation.


An exit interview was conducted and plans of correction developed with the Administrator Renita Campbell. A copy of this report and appeals rights was reviewed and left with Assistant Administrator, Renita Campbell.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20231108143305
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/19/2024
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a)Except for children’s residential facilities each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement is not as evidenced by:
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The Assistant Administrator, shall retrain all staff in proper CPI and provide evidence of training to CCLD via fax or email by POC due date of 6/13/24. On 6/5/24, Renita Campbell provided copies of CPI trainings conducted on 3/16/24. The instructor will be back to complete training for the remaining staff before POC due date and Renita will provide proof upon completion.
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Based on interview, S1 admitted grabbing C1, an action which caused bruises. This poses a potential personal rights risk to persons 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.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3