198601766-1-9-2023-11-AS-MVAO-CN7THF-20230118134440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601766
Report Date: 01/09/2023
Date Signed: 01/09/2023 06:20:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/05/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230105083040

FACILITY NAME:	OLIVIA ISABEL MANOR		FACILITY NUMBER:	198601766
ADMINISTRATOR:	KUNZ, ANA		FACILITY TYPE:	735
ADDRESS:	21515 S. FIGUEROA STREET		TELEPHONE:	(310) 328-5116
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	110	CENSUS: 93	DATE:	01/09/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Ana Kunz		TIME COMPLETED:	04:17 PM

ALLEGATION(S):

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Staff are not meeting resident's medical needs.
Staff are not meeting resident's hygiene needs.
Staff do not provide resident's clean clothing.
Staff are stealing from residents in care.
Staff did not ensure facility was free from bed bugs.
Staff are allowing residents to do drugs in the facility.

INVESTIGATION FINDINGS:

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On 01/09/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced visit at this facility and was greeted by Administrator Ana Kunz. LPA spoke to Kunz prior to entering the facility to conduct a risk assessment. Kunz informed LPA that the facility has COVID cases and that clients in isolated rooms. LPA explained the purpose of this visit is to investigate the allegations mentioned above.

The investigation consisted of the following: Interview with facility administrator Ana Kunz (S1) and staff #2-#5 (S2-S5), clients #1-#9 (C1-C9). A reveiw of admissions agreement, house rules, and pest control service agreement. A tour of the facility.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

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-20230105083040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVIA ISABEL MANOR	FACILITY NUMBER: 198601766
	VISIT DATE: 01/09/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not meeting resident's medical needs.
The details of the complaint stated residents are not taken to medical appointments and at times refused medical treatment by the staff. The reporting party did not mention the names of staff or residents that are involved in this complaint and did not provide further details on the allegation. Interviews conducted with clients #1-#9 (C1-C9) reported they are independent and arrange their medical appointments are made directly with their physician. If necessary, assistance is provided by the front office or made through their social worker. (C1-C9) reported having no issues with medical transportation offered by the facility. (C1-C9) reported there has been no refusal of medical treatment assistance by staff. Interviews conducted with staff #1-#5 (S-S5) disclosed no residents are refused medical treatment. Medical appointments are made at the front desk with med-techs. Medical transportation is available by appointment as requested. Transportation is handled by residents unless they do request assistance and it will be available at the front desk. Based on the information gathered and limited information provided by the reporting party, there is no evidence found to support the allegation above.

Allegation: Staff is not meeting the resident's hygiene needs.
Staff do not provide resident's clean clothing.
The reporting stated the residents are unkempt and not showered. by staff. The reporting party did not mention the names of staff or residents that are involved in this complaint and did not provide further details on the allegation. Interviews with clients #1-#9 (C1-C9) claimed they are independent and are responsible for their clothing, hygiene, and grooming. (C1-C9) claimed that staff may provide verbal assistance on hygiene or grooming. (C1-C9) reported they are responsible for washing their clothing, however, it is available for. caregiver to further assist with laundry if requested. Interviews with staff #1-#5 (S1-S5) reported the residents are independent. The facility will provide verbal directions on hygiene and grooming care. The residents are not forced by staff to regularly practice daily hygiene care as it violates their rights. Hygiene supplies are available for residents daily at the front office between 9 am -10 am or 9 pm -10pm. Some supplies offered at no cost are toothbrushes, toothpaste, a bar of soap, shampoo, conditioners, female items, and laundry detergent. According to (C1-C9), the staff provided hygiene kits as holiday gifts this past Christmas. Based on the information gathered and general information provided by the reporting party, there is no evidence found to support the allegations above.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230105083040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVIA ISABEL MANOR	FACILITY NUMBER: 198601766
	VISIT DATE: 01/09/2023

NARRATIVE

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Allegation: Staff is stealing from residents in care.
The details of the complaint accused staff of stealing or borrowing money from residents. The reporting party made no mention of the names of staff or residents that are involved in this complaint and did not provide further details on the allegation. Interviews with clients #1-#9 (C1-C9) claimed they are responsible for safeguarding their personal property including money. (C1-C9) reported they handle their finances and that staff does assist in the distribution of their personal & incidental (P&I). (C1-C9) have not been a victim of fraud or theft while in care at this facility. (C1-C9) asserted the staff workers are honest and never had issues with personal items or money being stolen or missing in their rooms. Interviews with staff #1-#5 (S1-S5) were all unaware of any theft or inappropriate handling of residents' funds. (S1-S3) claimed no residents have reported any wrongdoing or financial abuse from staff. (S1-S5) reported residents are reminded of house rules and safeguarding personal properties in residents' meetings and posted signs. Based on the information gathered and limited information provided by the reporting party, there is no evidence uncovered to back the allegation above.

Allegation: Staff did not ensure the facility was free from bed bugs.
It is alleged the facility is dirty and has bed bugs. The reporting party made no mentioned of the names of residents, room numbers, or locations that are involved in this complaint and did not provide further details on this allegation.

The investigation reveals the facility did not have bed bugs during visit on 01/09/23 . The management is ensuring the facility is being treated on an ongoing basis by Dewey Pest Control. Interviews with staff (S1-S3) stated there is no bed bug activity. The Department inspected random rooms #109 #112, and #113 all did not have bed bugs. The mattresses were inspected and revealed no bed bugs. Interviews with clients #1-#9 (C1-C9) claimed no bed bugs nor had any knowledge of beg bugs activities with other residents. Management has taken a proactive approach to ensure that the board and care facility is free from bugs. A valid prove of an annual service contract with a reputable company was provided by management. A tour of these rooms and the facility observed no bed bugs.

The Department in past inspection visits on 10/26/22 and 12/05/22 at this facility observed the facility to be clean and maintained in order. The Department has regularly observed housekeeping services being performed.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230105083040

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OLIVIA ISABEL MANOR	FACILITY NUMBER: 198601766
	VISIT DATE: 01/09/2023

NARRATIVE

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An interview with (S1-S3) expressed that they continue to ensure that the facility is in healthful conditions due to COVID-19 and extra work has been arranged by management and housekeeping staff to keep this facility in a safe and sanitary environment for staff and residents daily. (C1-C9) reported they are pleased with the upkeep of the facility and state their rooms and floors are clean and have never observed the facility to be unclean or dirty. Based on interviews and observation, there is no evidence to back the allegation.

Allegation: Staff is allowing residents to do drugs in the facility.
The reporting alleged staff allows residents to bring during illegal drugs inside the facility. The reporting party made no mention of the names of residents, staff, or witnesses who are involved in this complaint and did not provide further details on this allegation.

Interviews were conducted with staff, residents, and a review of house rules and admissions agreement revealed no evidence to corroborate the above allegation. Interviews with clients #1-#9 (C1-C9) claimed they have not observed any residents engage in illegal drugs inside the facility and that the staff does a good job in maintaining this community drug-free. The Department did not observe the facility in an unsafe environment. The facility has implemented mandatory "Mandatory Resident Meetings" which discuss house rules. policies and safety of residents and staff. In addition, “Alcoholic & Drugs Anonymous meetings are available for residents to attend on monthly schedules. These meetings discuss topics on self-support, education, and prevention of drugs and alcohol. There is no evidence to support the above allegation based on the information gathered and the limited information provided by the reporting party.

Based on the information gathered, an inspection of the facility, observation, analysis of records, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegation are Unsubstantiated.

An exit interview was conducted with Ana Kunz, and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2023

LIC9099 (FAS) - (06/04)

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