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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602122
Report Date: 12/14/2023
Date Signed: 12/15/2023 08:28:21 AM

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
12/06/2023 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20231206124848
FACILITY NAME:BENEVOLENT RESIDENTIAL CARE FACILITY INCFACILITY NUMBER:
198602122
ADMINISTRATOR:BEVERLY CREELFACILITY TYPE:
735
ADDRESS:9819 SOUTH 10TH AVENUETELEPHONE:
(310) 673-7750
CITY:INGLEWOODSTATE: CAZIP CODE:
90305
CAPACITY:4CENSUS: 2DATE:
12/14/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Beverly CreelTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Client sustained injuries due to staff neglect
Staff are not providing a comfortable environment for client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, December 14, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Licensee/Administrator Beverly Creel. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Staff members 1-2 (S1-S2) and clients 1-2 (C1-C2) were interviewed. LPA Bunker posed pertinent questions directly related to the nature of the complaint. From these discussions, it was unanimously reported by S1-S2 and C1-C2 that there were no instances of client injuries attributable to staff neglect. S1-S2 and C1-C2 affirmed that the staff is consistently providing a comfortable and suitable living environment for all clients under their care. A comprehensive inspection of the facility was undertaken, encompassing both the interior spaces and the external grounds. This tour was aimed at observing and identifying any potential indications of neglect, abuse, or immediate health and safety risks. See continued LIC812-C page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
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 2
Control Number 11-AS-20231206124848
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: BENEVOLENT RESIDENTIAL CARE FACILITY INC
FACILITY NUMBER: 198602122
VISIT DATE: 12/14/2023
NARRATIVE
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Continued LIC812-C page 2
During this inspection, no signs of neglect or abuse were observed. LPA Bunker conducted a thorough review of client records to ensure compliance and proper care standards. In line with standard procedure, LPA Bunker requested copies of relevant supporting documents for further analysis and record-keeping.
Allegation #1: Client sustained injuries due to staff neglect. Staff 1-2 (S1-S2) and clients 1-2 (C1-C2) interviewed stated that none of the clients sustained any injuries due to staff neglect. C1-C2 stated they never witnessed staff abusing any of the clients. C1-C2 stated they were happy living at the facility and staff treats them like family. C1-C2 stated the staff is their family. S1-S2 and C1-C2 stated staff is providing care and supervision as necessary to meet the client's needs. S1-S2 and C1-C2 denied the allegation.
Allegation #2: Staff are not providing a comfortable environment for clients. Staff 1-2 (S1-S2 and clients 1-2 (C1-C2) stated staff are providing a comfortable living environment for clients in care. C1-C2 stated they are not afraid of the facility staff. C1-C2 stated they were happy in the home. S1-S2 and C1-C2 denied the allegation.
The Investigation revealed the following: Interviews with S1-S2, C1-C2, and the Westside Regional Center Service Coordinator (SC) unanimously indicated that none of the clients exhibited any facial bruises or injuries. S1-S2, C1-C2, and the SC collectively affirmed that the clients do not harbor any fear towards the staff. C1-C2 particularly noted that the staff members treat the clients akin to family members. It was consistently reported by S1-S2, C1-C2, and SC that the clients are residing in a comfortable, safe, and healthy environment, with all their care needs being adequately met. S1 disclosed that she had proactively self-reported the allegations to various authorities, including the Community Care Licensing Division (CCLD), Westside Regional Center (WRC), Adult Protective Services (APS), Long Term Care Ombudsman (LTCO), and the Inglewood Police Department, before the formal lodging of the complaint. On December 05, 2023, representatives from the Westside Regional Center, APS, and the Inglewood Police Department (IPD) visited the facility to conduct a thorough investigation into the complaints. The investigations by the WRC and APS concluded with the determination that the allegations were unsubstantiated. Officers from the IPD, following up on APS report #921097, stated that their investigation did not reveal any signs of neglect, abuse, or immediate health and safety threats. The IPD officer expressed no concerns and declared the case closed. LPA Bunker did not see any bruises or injuries on the client. S1-S2 and C1-C2 categorically denied all allegations.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. There were no deficiencies cited. Exit interview conducted.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2