198601965-2-22-2024-11-AS-EMAZ-D35USW-20240307145057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601965
Report Date: 10/12/2023
Date Signed: 02/22/2024 03:37:25 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
10/04/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20231004120545

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: 2	DATE:	10/12/2023
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	DSP VONERIC JOHNSON		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility did not ensure that resident received prescribed medications.
Facility is not following resident's dietary plan.
Facility is not properly training staff.

INVESTIGATION FINDINGS:

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THIS REPORT SUPERSEDES THE REPORT DATED 10/12/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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-20231004120545

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: 10/12/2023

NARRATIVE

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Regarding Allegation #1: Facility did not ensure that resident received prescribed medications.

This complaint alleged that staff did not have prescribed insulin or metformin for C1 use. On 10/12/2023 LPA Calderon obtained and reviewed the physician order (dated 09/23/2023 and 10/04/2023). The order states to take one 500 mg metformin tablet by mouth twice a day with morning and evening meals. MAR for C1 notes that metformin was given to C1 from 10/01/2023 to 10/08/2023. LPA Calderon conducted an interview with A1. A1 states that C1 was a client from 09/28/2023 to 10/08/2023. A1 states that C1 did not arrive at the facility with insulin or metformin. A1 states that staff ordered metformin for C1 on 09/23/2023 and 10/04/2023. LPA Conducted an interview with S1. S1 states that S1 reviewed C1 medical records and metformin was ordered on 09/23/2023 and based on MAR, metformin was given to C1 from 10/01/2023 to 10/08/2023. LPA Calderon could not interview C1 as C1 moved out of the facility on 10/08/2023 and C2 is non-verbal. LPA Calderon conducted an interview with C3. C3 states that staff has never run out of C3 medications and has never missed giving C1 medications on time.

Regarding Allegation #2: Facility is not following resident’s dietary plan.

This complaint alleged that staff did not follow R1 diabetic meal plan by serving R1 cereal. On 10/12/2023 LPA Calderon obtained and reviewed the physician report (dated 09/21/2023) The physician report states C1 has type 2 diabetes and a diabetic diet is suggested. LPA Calderon conducted an interview with A1. A1 states that C1 is conserved and that C1 mother advised staff that C1 only likes cereal in the morning and at night and to serve a meal for lunch. A1 states that there was no diabetic meal plan for C1. LPA Calderon conducted an interview with S1. S1 states that S1 reviewed medical records for C1 and noted C1 was diabetic. S1 spoke to C1 conservator who advised S1 that C1 only would eat cereal in the morning and at night. S1 states that staff called C1 doctor office on 09/26/23 and 09/27/23 to have the physician order a dietetic meal plan for C1 but there was not enough time and C1 moved out on 10/08/2023. LPA Calderon could not interview C1 as C1 moved out of the facility on 10/08/2023 and C2 is non-verbal. LPA Calderon conducted an interview with C1. C1 states that C1 is not diabetic, and that staff serves 3 meals per day.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231004120545

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: 10/12/2023

NARRATIVE

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Regarding Allegation #3: Facility is not properly training staff.

This complaint alleged that staff are not given proper training to care for residents in care. On 10/12/2024 LPA Calderon obtained and reviewed the staff training (dated 10/06/2023). The training topic is” diabetes”, three staff took the training. LPA Calderon conducted an interview with A1. A1 states that C1 was the first diabetic client for the facility. A1 states that S1 provided training to staff that would care for C1 while C1 was at the facility and then S1 would follow up on additional training of staff that were not working at the time of training. LPA Calderon conducted an interview with S1. S1 states that S1 conducted “diabetic” training for staff on 10/06/2023. S1 states that the training was provided to staff that would care for C1. S1 states that additional staff training would be provided to staff that were not working on 10/06/2023.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “facility did not ensure that resident received prescribed medications” “facility is not following residents dietary plan” “facility is not properly training staff” is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Licensee Voneric Johnson (A1)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC9099 (FAS) - (06/04)

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