198602229-11-7-2020-11-AS-AJKK-BVVUQG-20201201144708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602229
Report Date: 11/07/2020
Date Signed: 11/07/2020 01:52:04 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/27/2020 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200727130048

FACILITY NAME:	ARLINGTON POST GUEST HOME		FACILITY NUMBER:	198602229
ADMINISTRATOR:	LACANILAO, LAUREANA		FACILITY TYPE:	740
ADDRESS:	1433 POST AVE		TELEPHONE:	(310) 328-6086
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY:	6	CENSUS: 5	DATE:	11/07/2020
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Laureana Lacanilao, Administrator		TIME COMPLETED:	02:21 PM

ALLEGATION(S):

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Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Laureana Lacanilao, facility Administrator.

On 07/31/20, LPA Montoya conducted a virtual visit of the physical plant and interviewed Laureana Lacanilao and Yolanda Martinez. LPA requested copies of a current staff roster, resident roster, In-Service Training with a proof of staff attendance or certificates, House Rules and/or Code of Conduct/ethics Policy, (R1’s) admission agreement, pre-placement appraisal, physician’s report, emergency contact information, progress notes or patient chart, medications, and other pertinent documents relevant to the investigation.

On 11/07/20, LPA Jones delivered findings to administrator, Laureana Lacanilao. The allegation revealed

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2020

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-20200727130048

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
MONTEREY PARK, CA 91754

FACILITY NAME: ARLINGTON POST GUEST HOME	FACILITY NUMBER: 198602229
	VISIT DATE: 11/07/2020

NARRATIVE

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the following: For allegation (Staff handled resident in a rough manner). It was alleged that the facility staff abused resident while in care. Staff 1 and 2 denied the allegation during their interviews. Staff 1 and 2 stated that resident 1 would scream and yell at staff when staff tried to assist her. Staff 1 and 2 stated that resident 1 would say someone was hitting her but none of the staff were in her room. LPA tried to locate resident 1 for an interview but was unable to contact R1 or locate where she currently resides. LPA made three attempts in trying to contact R1's family member but was unable to make contact. Residents 2-4 revealed to LPA during their interviews that they like living in the home and staff are always nice. Resident 2-4 stated that they never observed staff being mean to other residents. Resident 4 stated that she would hear R1 screaming at staff and asking for help. Resident 4 said R1 appeared to be confused and frightened.

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 unsubstantiated.

A telephonic exit interview was conducted with Laureana Lacanilao and an electronic copy of the report was provided via email for signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2020

LIC9099 (FAS) - (06/04)

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