198601844-9-18-2024-11-AS-RORN-D9WKZB-20241010082026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601844
Report Date: 09/18/2024
Date Signed: 09/18/2024 04:03:17 PM

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
09/12/2024 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240912092157

FACILITY NAME:	PEPPERWOOD AVENUE FACILITY		FACILITY NUMBER:	198601844
ADMINISTRATOR:	DAVENPORT, RENEE		FACILITY TYPE:	735
ADDRESS:	4735 PEPPERWOOD AVE		TELEPHONE:	(562) 982-4237
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	3	CENSUS: 3	DATE:	09/18/2024
		UNANNOUNCED	TIME BEGAN:	10:58 AM
MET WITH:	Sheleania Hampton		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Facility staff speaks inappropriately and yells at residents in care.

INVESTIGATION FINDINGS:

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On 09/18/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint visit at this facility. LPA met with Administrator, Sheleania Hampton. LPA explained the purpose of this visit is to gather information for the allegation mentioned above.

The investigation consisted of the following: LPA received copies of Client Roster, Staff Roster, In Service Training Record for staff training, Personal Rights, Physician’s Report, Appraisal/Needs and Services Plan, 1st Quarter ISP Review (period report: 08/01/23-10/31/23, SCB Counseling 3rd Quarter Report (dated: 05/30/24), and Behavior Daily Tracking Sheet for C1. LPA interviewed client #1 (C1), facility Administrator (A1), staff #1 (S1) and attempted to interview clients #2-#3 (C2-C3). Additionally, LPA conducted an inspection of the facility.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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-20240912092157

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: PEPPERWOOD AVENUE FACILITY	FACILITY NUMBER: 198601844
	VISIT DATE: 09/18/2024

NARRATIVE

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Investigation revealed the following:

Allegation: Facility staff speaks inappropriately and yells at residents in care. It is alleged that staff are mistreating, speaking inappropriately, and yelling at a client in care.

09/18/24, LPA interviewed S1, and they denied ever mistreating, yelling, or have speaking inappropriately towards C1 or any other clients in care. S1 stated that fabricating stories against staff and other clients is very common for C1, and staff can do is talk to him and document such behavior. S1 stated that all staff has been trained in understanding clients rights and respecting them.

An interview conducted with the facility Administrator (A1) revealed that the facility provides all staff with training regarding the personal rights of clients. She indicated that the client’s rights are being protected and promoted through training and staff meetings. A1 expressed that the client’s personal rights are discussed during their monthly council meetings. Furthermore, A1 stated that C1 has fabricated stories in the past, and that behavior is very common from them towards staff and the other clients.

On 09/18/24, LPA interviewed C1, and it revealed that they are aware of their rights because staff is always telling them and reminding them what their rights are. When LPA asked C1 if staff at this facility has ever yelled or mistreated them or any of the other clients, C1 stated that they think staff has yelled at them, but they are not sure when. C1 stated that they are satisfied with the facility and the services being provided.

Based on observation, evidence gathered, interviews conducted, and records reviewed, there was not enough supportive evidence to concur with the reported allegation. 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 allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Sheleania Hampton, and a copy of the report along with Appeal Rights was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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