198602078-6-13-2021-11-AS-AJKK-C47NNS-20210621103711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602078
Report Date: 06/11/2021
Date Signed: 06/13/2021 09:19:29 PM

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 HOUSE		FACILITY NUMBER:	198602078
ADMINISTRATOR:	STEPHANY HARLOW		FACILITY TYPE:	740
ADDRESS:	2842 EL DORADO STREET		TELEPHONE:	(310) 796-6625
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 1	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Jonathan Mesko/Ed Long		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Facility failed to report the change of chief corporate officer.

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 allegation mentioned above. LPA Montoya called the facility and spoke with Executive Director Jonathan Mesko and 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. Licensee 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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
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)

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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 failed to report the change of chief corporate officer.

It is alleged the facility failed to report the change of chief corporate officer. 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, the facility's personnel report (LIC 500) shows there have been no changes in the chief corporate officer of the organization of the facility. The licensee and staff #2 denied that there is a change in the chief corporate officer of the organization of the facility. Interviews with Resident #1, Staff #3, #4, and #5 indicated that they are not aware of any change in the chief corporate officer of the facility. Witnesses #1 and #2 stated the chief corporate officer of the organization has not changed.

Based on information gathered, LPA did not find sufficient evidence to support the allegation, “Facility failed to report the change of chief corporate officer of the facility.” This is evidenced by LPA’s observations, interviews, and record reviews.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to Executive Director Jonathan Mesko.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (323) 981-4934
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)

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