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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602078
Report Date: 06/11/2021
Date Signed: 06/13/2021 09:18:47 PM

Substantiated


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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2021 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20210608153920
FACILITY NAME:CARING HOUSEFACILITY NUMBER:
198602078
ADMINISTRATOR:STEPHANY HARLOWFACILITY TYPE:
740
ADDRESS:2842 EL DORADO STREETTELEPHONE:
(310) 796-6625
CITY:TORRANCESTATE: CAZIP CODE:
90503
CAPACITY:6CENSUS: 1DATE:
06/11/2021
UNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Ed Long/Jonathan MeskoTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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The facility does not have a qualified and currently certified administrator.
INVESTIGATION FINDINGS:
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On 6/11/2021, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced complaint visit at the above facility to investigate and deliver the findings of the allegations mentioned above. LPA Montoya called the facility and spoke with Executive Director Jonathan Mesko. LPA conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. LPA Montoya met with Executive Director Jonathan Mesko, and LPA explained the purpose of the visit. Chief Corporate Officer/Ed Long arrived later and joined the visit.

The investigation consisted of the following: A tour of the facility; interview with the licensee, staff, resident, and board members; and a review of administrator’s certificates, personnel report (LIC 500), personnel records (LIC 501), resident roster, and staff roster.

REPORT CONTINUED IN LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 11-AS-20210608153920
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
MONTERY PARK, CA 91754
FACILITY NAME: CARING HOUSE
FACILITY NUMBER: 198602078
VISIT DATE: 06/11/2021
NARRATIVE
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The investigation revealed the following:

Allegation: The facility does not have a qualified and currently certified administrator.
It is alleged the facility does not have a qualified and currently certified administrator. LPA conducted interviews with the Licensee, Staff #2-#5, Resident #1, Witness #1, and Witness #2. Staff #1 and Staff #6 were not present and not available for interview during the visit. Based on record review, Staff #1’s facility administrator certificate expired on 5/27/2021. LPA reviewed the licensee’s notice to Staff #1 on “Change of Relationship” indicating Staff #1 was on leave of absence effective 5/20/2021 and due to return on 6/11/2021. However, based on the Interview with the Licensee and Staff #2, Staff #1 has not returned yet. Staff #3 stated in an interview that Staff #1 is on medical leave, and she does not know if there is a backup administrator during Staff #1’s absence. She said Staff #2 oversees the day-to-day activities in the facility. The licensee and Staff #2 mentioned that Staff #4 and #5 are currently the backup administrators, and they are both available by phone and in person if needed. But there has not been a need for them on the premises, according to the licensee. Per record review, Staff #4’s administrator certificate expires on 6/19/2021. Staff #4 revealed in a phone interview that Staff #6 is the current facility administrator. She stated she is listed as a designed substitute for the administrator, but she has not worked in this capacity for this facility for a long time. She mentioned that she has no knowledge that the administrator is on leave and no one from the facility has notified her to cover as a back-up for the administrator during her absence. Per telephone interview with Staff #5, she is a certified administrator but never worked for this facility with this role. She stated she worked for the facility as a marketing consultant about two years ago. Resident #1 stated Staff #2 is the current administrator of the facility. Witness #1 mentioned in an interview that there is a certified administrator of the facility, but she does not know the name of the individual. Witness #2 stated Staff #1 is the facility administrator, but she is currently on leave. She stated there are two backup administrators, however, she does not know their names. Based on the information gathered, there was no qualified and currently certified administrator or a qualified designated substitute on the premises during the administrator's absence. There was no qualified and currently certified administrator or a qualified designated substitute on the premises from May 20, 2021 to June 11, 2021.

Based on LPAs observations, interviews, and record reviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview conducted and a copy of the appeal rights issued and discussed with Executive Director Jonathan Mesko.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20210608153920
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
MONTERY PARK, CA 91754

FACILITY NAME: CARING HOUSE
FACILITY NUMBER: 198602078
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2021
Section Cited
CCR
87405(A)
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(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
This requirement was not met as evidenced by:
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Licensee agreed to submit an administrator packet to designate Staff #4 as the primary administrator in place of Staff #1 and ensure that Staff #4 shall be on the premises a sufficient number of hours as the responsible and accountable person for the management and administration of the facility. Licensee will email an updated LIC 500 by the POC due date.
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Based on LPA's observations, interviews, and record reviews, the licensee failed to ensure that a qualified and currently certified administrator is available on the premises or a qualified designated substitute on the premises during the administrator's absence. The administrator (Staff #1) has been on leave since 5/20/2021, and her administrator certificate expired on 5/27/2021 while the designated substitute (Staff #4) was never on the premises during the administrator’s absence; therefore, there was no qualified and currently certified administrator or a qualified designated substitute on the premises responsible and accountable for the management and administration of the facility from May 20, 2021, to June 11, 2021.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3