198601865-3-9-2023-11-AS-MVAO-CQCT5U-20230328142604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601865
Report Date: 03/09/2023
Date Signed: 03/09/2023 12:01:46 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
02/02/2023 and conducted by Evaluator Martessa Brown

COMPLAINT CONTROL NUMBER: 11-AS-20230202142959

FACILITY NAME:	ADE EMMANUEL ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	198601865
ADMINISTRATOR:	ADEBAYO OSISANYA		FACILITY TYPE:	735
ADDRESS:	10972 LOU DILLON AVE		TELEPHONE:	(323) 537-8515
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90059
CAPACITY:	4	CENSUS: 4	DATE:	03/09/2023
		UNANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Adebayo Osisanya		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Resident wandered from the facility due to lack of staff supervision
Staff did not report an incident involving resident who left facility unassisted

INVESTIGATION FINDINGS:

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On 3/9/23, Licensing Program Analyst (LPA) Martessa Brown conducted a subsequent complaint investigation for the above listed allegations.LPA verified with Administrator there is no Covid-19 Cases. LPA met with, and the purpose of the visit was explained.

The investigation consisted of the following: On 2/9/23, LPA Brown conducted the initial complaint visit. LPA conducted interviews with the Administrator staff S2-S3 and clients C1-C2. LPA reviewed and obtained the following records: C1 file emergency contact, physician report, IPP, client notes and staff #1-2 training file. Interviews were later conducted with C-3 and C4 and witness (W1) and (W2).

The investigation revealed the following: Interviews and records review.

LIC 9099 is on the next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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-20230202142959

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: ADE EMMANUEL ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 198601865
	VISIT DATE: 03/09/2023

NARRATIVE

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Regarding allegation #1: Staff failed to treat resident with dignity and respect

On 2/9/23, it was alleged that client is being verbally abused and not treated with respect. During interviews conducted, Administrator and staff S2-S3 stated they are not verbally abusive with clients. Administrator and staff denied the allegation, staff stated all clients are treated with respect and have not witness verbal abusive. During interview with S2, stated they speak Spanish to client and have never used abusive speech. During interviews conducted 3 out of 4 clients stated they are not verbally abusive by staff and are treated with respect. Interviews conducted with Witness (W1), stated one of the clients likes to exaggerate when communicating with others. W2 stated spoken confirmed 3 out of 4 stated they were not verbally abused. Based on interviews and documents the above allegation is unsubstantiated.

Regarding allegation #2 Staff withhold food from resident

On 2/9/23, it was alleged that clients are getting smaller portions of food. During interviews with Administrator and staff S2-S3, all stated residents are given the same size food portions. Staff stated clients are provided 3 meals a day including snacks. During interviews, 3 out of 4 clients stated they are getting enough food and receive 3 meals a day and snacks. Interview conducted with W2 stated, clients did not have concerns with getting enough food except for one. LPA observed during visit C1 receiving breakfast such as pancakes, sausage and eggs. LPA also observe refrigerator in C1's bedroom. Based on interviews and documents above allegation is unsubstantiated.

Based on interviews conducted and records review, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted and a hard copy was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

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