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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601841
Report Date: 02/10/2023
Date Signed: 02/10/2023 02:55:12 PM

Unsubstantiated


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
01/04/2022 and conducted by Evaluator Luis Mora
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220104101040
FACILITY NAME:DEVLIN FACILITYFACILITY NUMBER:
198601841
ADMINISTRATOR:LA MARR, KEISHAFACILITY TYPE:
735
ADDRESS:20516 DEVLIN AVETELEPHONE:
(562) 278-2127
CITY:LAKEWOODSTATE: CAZIP CODE:
90715
CAPACITY:3CENSUS: 3DATE:
02/10/2023
UNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Tranae Gatlin - AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Staff pushes clients.
Staff does not treat clients with dignity.
Staff are not trained to administer medications.
Facility is not staffing per ratio requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Luis Mora and Erik Zaragoza conducted an unannounced subsequent complaint visit to determine the validity of the above-mentioned allegations. LPA met with Tranae Gatlin (Administrator) and explained the reason for the visit.

The investigation consisted of the following: On 01/13/22, LPA obtained copies of client and staff rosters. LPA interviewed administrator, Client 1 - Client 3 (C1 - C3), and Staff 1 - Staff 3 (S1 - S3). On 01/27/23. LPA interview facility nurse via telephone. On 02/08/2023, LPA interviewed regional center representative via telephone. Today's visit, LPAs obtained copies of client and staff rosters, staff mediation training certificates, in-service medication training/refresher dated 03/08/22 and interviewed the current administrator and Staff 4 (S4).

The investigation revealed the following: regarding the allegation "staff pushes clients", it is alleged that a staff pushes the clients especially C3. Staff interviewed denied the allegation. Clients could not corroborate the allegation due to intellectual capabilities. Interviewed with regional center representative revealed that they have no concerns about this facility. (Continued to LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
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 2
Control Number 28-AS-20220104101040
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: DEVLIN FACILITY
FACILITY NUMBER: 198601841
VISIT DATE: 02/10/2023
NARRATIVE
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Regarding the allegation "staff does not treat clients with dignity", it is alleged that the PM shift staff puts the clients to sleep by 5pm to not deal with them, they have no interaction with the clients and most of
the time the PM shit staff don't cook food. Staff interviewed denied the allegation. Clients could not corroborate the allegation due to intellectual capabilities. Regional center representative stated that the times they have visited the facility they have observed staff interacting with the clients and staff cooking meals for the clients. During LPA's visit on 01/13/2022 and today, the LPA observed a staff interacting with the clients and food being prepared.

Regarding the allegation "staff are not trained to administer medications", it is alleged that the medication is being given by regular people and none have a license. Staff interviewed denied the allegation and stated that all facility staff are provided medication training during their orientation by a registered nurse. Regional center representative confirmed the staff statements. Facility nurse also confirmed the staff statements and stated that he has also conducted medication in-service training/refreshers. Records reviewed show that the last in-service medication training/refresher was conducted on 03/08/2022 by the facility nurse and LPA observed medication training certificates for the facility staff.

Regarding the allegation "facility is not staffing per ratio requirements", it is alleged that there should be 2 staff in the 2nd shift. Staff interviewed denied the allegation and stated that there is always 2 staff in the AM and PM shift, and 1 staff in the NOC shift. Staff also stated that the facility contracts staff from an outside employment agency to meet their staffing ratio requirements. Regional center representative confirmed the staff statements and stated that the times he has visited the facility he has seen 2 staff at the facility. Clients could not corroborate the allegation due to intellectual capabilities. During LPA's visit on 01/13/2022 and today, the LPA observed two staff at the facility.

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 allegations are unsubstantiated.

Exit interview held and a copy of the report was provided
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2