198601665-3-7-2024-28-AS-RORN-D3CMHK-20240314093739

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601665
Report Date: 03/07/2024
Date Signed: 03/07/2024 01:26:16 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240206150056

FACILITY NAME:	ELEGANT CARE INC.		FACILITY NUMBER:	198601665
ADMINISTRATOR:	JEWEL REESE		FACILITY TYPE:	740
ADDRESS:	834 E. 74TH ST.		TELEPHONE:	(323) 821-1601
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90001
CAPACITY:	6	CENSUS: 6	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	12:59 PM
MET WITH:	Ford Hunt - Direct Support Support		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff did not prevent facility roof from being in disrepair

INVESTIGATION FINDINGS:

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**This report supersedes report dated 2/9/2024. The reason it is being superseded is to correct the deficiency type of the citation that was issued on 2/9/2024. Title 22 Section 87303(a) was cited as a Type A deficiency, however it should have been citated as a Type B deficiency. The finding will remain the same.**

Licensing Program Analsyt (LPA) Erik Zaragoza conducted an unannounced complaint visit in regards to the allegation listed above. LPA explained the purpose of the visit to Chyna Tucker, caregiver for the facility, and was granted entrance. Administrator Jewell Reese was not able to arrive at the facility due to being hospitalized.

The investigation consisted of the following: LPA Erik Zaragoza interviewed staff #1 - 2 (S1 - S2), residents #1 - 2 (R1 - R2), and conducted a tour of the facility focusing on the ceiling in the living room as well as in rooms #3 and #4.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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 28-AS-20240206150056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ELEGANT CARE INC.	FACILITY NUMBER: 198601665
	VISIT DATE: 03/07/2024

NARRATIVE

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The investigation revealed the following: In regards to the allegation that "Staff did not prevent facility roof from being in disrepair", it is alleged that for the past two (2) years that whenever it has rained, including in recent days from this report being made, rainwater has leaked through the roof and into the living room, along with resident rooms #3 and #4. During interviews with residents, neither of the two (2) residents interviewed corroborated the allegation, although they live in rooms #1 and #2, and one of the residents explained that they cannot see. The residents in rooms #3 and #4 were not available to be interviewed because they were out in the community. During interviews with the two (2) staff members present in the facility, both of them corroborated that they have heard of issues with rainwater leaking into the facility through the roof during the days that it rains. S1 and S2 stated that they have heard that repair on the roof is being initiated, however they have not personally seen water leak through the roof due to not being at the facility when it has rained in recent days. During the physical plant tour, LPA observed that there were holes in the ceiling of the living room approximately one (1) inch in diameter through which rainwater may be able to leak in from. In room #3 there was an observed hole approximately five (5) inches in diameter, and one of the staff members explained that through this opening rainwater has come into the room. Pictures were taken of the holes found in the living room as well as in room #3. No holes in the ceiling were observed in room #4, although one staff member indicated that rainwater has come in around the base of the ceiling fan of the room, which has forced the staff to duct tape the light switch in the room to prevent any electrical hazards to the resident. LPA observed that there was still duct tape covering the light switch of the room, preventing anyone from switching it on or off.

Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the caregiver Chyna Tucker.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240206150056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ELEGANT CARE INC.	FACILITY NUMBER: 198601665
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/07/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/23/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This regulation is not met as evidenced by:	1 2 3 4 5 6 7	Administrator is to ensure that the the facility's roof and ceiling is in good repair at all times. Administrator is to send an invoice of the roof repairs to LPA by the POC due date.
	8 9 10 11 12 13 14	Based on observation and interview, LPA determined that there are currently gaps in the ceiling of the facility through which rainwater has leaked into the facility, which poses a potential health and safety risk to the residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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