198601965-10-5-2023-11-AS-MVAO-CXKTHF-20231114134440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601965
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:57:49 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, 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
06/19/2023 and conducted by Evaluator Jeremiah Randle

COMPLAINT CONTROL NUMBER: 11-AS-20230619085713

FACILITY NAME:	LURAY HOME		FACILITY NUMBER:	198601965
ADMINISTRATOR:	SHIRENA L MUHAMMAD		FACILITY TYPE:	735
ADDRESS:	930 E. LURAY STREET		TELEPHONE:	(562) 612-3752
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	3	CENSUS: 3	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	08:14 AM
MET WITH:	Brandon Hayes DSP		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff are not meeting resident's G-tube needs
Staff are not meeting resident's diapering needs
Staff are not applying resident's medication

INVESTIGATION FINDINGS:

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On 10/05/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced visit to deliver the findings of the complaint allegation(s): Staff are not meeting resident's G-tube needs, Staff are not meeting resident's diapering needs, Staff are not applying resident's medication. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s). with DSP Brandon Hayes.

The Investigation Consisted Of The Following

On 06/28/23 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced 10-day visit to Luray Home. LPA was met by Veronica Perez DSP. The Purpose of the visit was explained to investigate the allegations listed above. LPA requested pertinent documents pertaining to the investigation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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-20230619085713

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LURAY HOME	FACILITY NUMBER: 198601965
	VISIT DATE: 10/05/2023

NARRATIVE

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The following documents were provided and reviewed by LPA Randle: Resident Roster, Staff Roster, Copy of resident file for (C1) including physicians’ reports, Dr's notes and orders, MARs nursing notes, feeding schedules, bowel and bladder schedules, body check notes, hospital records/discharge records, staff training logs re G/J tube. On 10/05/2023 LPA conducted follow-up interviews with (5) staff members and attempted to interview (2) out of (2) Clients.

The Investigation Revealed The Following.

Allegation: Staff are not meeting resident's G-tube needs

LPA interviewed staff. S1-S4 all staff denied the allegation: Staff stated the G-tube is sometimes pulled on by client causing issues such as partial movement and redness. Per LPA's review of Client #1’s medication administration records (MAR) and interview with four staff (S1-S4), an adhesive cream is applied to the G-tube as prescribed and as needed after cleaning the G-tube. Staff S1-S5 stated they are trained to assist Client #1 with G-tube care and maintenance. Client is seen by a physician weekly regarding medical issues Client 1 was not able to provide comprehensible feedback during the investigation due to medical issues. Based on observations, records reviews and interviews, there is no sufficient evidence to support or corroborate the above allegation.

Allegation: Staff are not meeting resident's diapering needs

LPA interviewed staff. S1-S5 all staff denied the allegation: Staff are not meeting resident's diapering needs. Staff S1-S5 stated they are trained to assist all Client’s with activities of daily living (ADL) as well as diapering needs. Interviews with Staff, S1-S5 staff stated Clients are checked and changed throughout the day after each incident of soiling. Staff would change diapers the diaper checked and change if needed. Staff S1-S5 stated they never leave residents in a soiled diaper. LPA Randle reviewed notes that revealed body checks and changing. when needed. Interviews conducted and records reviewed did not concur or support the above allegation. Client 1 was not able to provide comprehensible feedback during the investigation. Client 2 was interviewed and stated Staff does assist client when needed and has no complaints regarding ADL or staff care, client also stated to LPA he likes living at the facility. Based on observations, records reviews and interviews, there is no sufficient evidence to support or corroborate the above allegation.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230619085713

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LURAY HOME	FACILITY NUMBER: 198601965
	VISIT DATE: 10/05/2023

NARRATIVE

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Allegation: Staff are not applying resident's medication

LPA interviewed staff. S1-S5 all staff denied the allegation: Staff are not applying resident's medication. Staff S1-S5 stated they are trained to assist all Client’s with medications. Interviews with Staff S1-S5 all agree that the clients always get their medication on time and as prescribed. LPA reviewed C1’s Mars and Medical progress notes no discrepancy was found and records indicated medication was given or applied per doctors’ orders. Client 2 was interviewed and stated Staff does assist client when needed and has no complaints regarding receiving medication as prescribed and on time. Interviews and records reviewed did not support or corroborate the above allegation. Based on observations, records reviews and interviews, there is no sufficient evidence to support or corroborate the above allegation.

Findings

Based on information gathered, the LPA did not find sufficient evidence to support Allegation(s) Staff are not meeting resident's G-tube needs, Staff are not meeting resident's diapering needs, Staff are not applying resident's medication.

Although the allegation 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(s) are Unsubstantiated.

No citations were issued at this time.

An exit interview was conducted and a copy of the LIC 9099 was provided to Staff Jasmine Batise DSP.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jeremiah Randle
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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