198601882-1-20-2022-11-AS-AJKK-CD3SGG-20220401135156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601882
Report Date: 01/20/2022
Date Signed: 01/20/2022 02:45:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/12/2022 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220112154126

FACILITY NAME:	HARCOURT ADULT HOME		FACILITY NUMBER:	198601882
ADMINISTRATOR:	LINDA HUDSON		FACILITY TYPE:	735
ADDRESS:	5200 ANGELES VISTA BLVD		TELEPHONE:	(323) 295-4555
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90043
CAPACITY:	6	CENSUS: 6	DATE:	01/20/2022
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Alex Ofuonye, Senior Director of Group Homes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Covid-19 reporting protocols are not being followed.

INVESTIGATION FINDINGS:

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On 01/20/2022, Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the following allegation. LPA Agard met with the Senior Director of Group Homes, Alex Ofuonye and explained the purpose of the visit was to gather information regarding this complaint.

LPA requested copies of the following documents: Client roster, Staff Roster, Copy of incident report, Email correspondents to South Central Regional Center (SCLARC). All requested documents were received at the time of visit.

The investigation consisted of the following: LPA Agard conducted interviews with staff, witnesses and reviewed records.

On 01/20/2022, LPA Agard delivered findings.
Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022

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-20220112154126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: HARCOURT ADULT HOME	FACILITY NUMBER: 198601882
	VISIT DATE: 01/20/2022

NARRATIVE

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Regarding the allegation: Covid-19 reporting protocols are not being followed. It’s being alleged that the facility is not reporting active covid cases to the proper agencies or cleaning and sanitizing appropriately to prevent the spread of illness. The investigation revealed the following: During interviews with staff, 3 of the 3 denied the allegation to be true. S1 states, the active covid cases were reported via an incident report to Community Care Licensing (CCL) and to South-Central Los Angeles Regional Center (SCLARC). S1 also states, The Department of Public Health was contacted and informed that they do not meet the criteria of being an outbreak facility. S1 states facility staff are to clean every two hours and that’s what’s mention in their mitigation plan. S2 confirmed being informed by management about the positive Covid case. “I read it in an email.” S3 states, I was notified by the Administrator via a phone call. Both S2 and S3 state they were trained to clean and disinfect the facility after each use or every two hours, whichever comes first.

During interviews with the witnesses, 2 out of 2 denied the allegation to be true. W1 confirmed receiving a call from the Administrator. “I received a call from the Administrator and then a report followed a couple days later.” W2 states, the supervisor informed me about my relatives’ exposure and then their negative test results.” LPA attempted to interview all clients but was unable to due to communication barriers. During a record review, LPA Agard confirmed receiving an email on January 3^rd, 2022 at 6:41pm from Administrator, Linda Hudson stating the facility had a positive Covid case and an incident report would follow. An Incident report was received, and LPA Agard began tracking the facility’s positive covid cases on January 4^th, 2022. During a review of mitigation plan, it states the facility has plans for infection control which includes routine and frequent cleaning and disinfection of rooms and common areas to be completed by staff.

Based on interviews conducted, and record review, the preponderance of evidence standard has not been met. 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, and a copy of the report was given.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Troy Agard
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022

LIC9099 (FAS) - (06/04)

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