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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602263
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:55:42 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/03/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230203151839
FACILITY NAME:NP CARE HOMEFACILITY NUMBER:
198602263
ADMINISTRATOR:TATUM, RONICFACILITY TYPE:
740
ADDRESS:3767 VIRGINIA ROADTELEPHONE:
(323) 205-5145
CITY:LOS ANGELESSTATE: CAZIP CODE:
90016
CAPACITY:6CENSUS: 6DATE:
02/23/2024
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Krystal PerkinsTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff did not dispense medication as prescribed.
Staff falsified records.
Staff did not assist resident with incontinence needs.
Staff did not change resident's clothing.
Staff serve small portions of food to residents.
Facility does not purchase enough food for residents.
INVESTIGATION FINDINGS:
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On 02/23/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted a subsequent unannounced visit to the facility and was greeted by Krystal Perkins, Administrator. LPA explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by LPA Martessa Brown on 02/10/23. A subsequent visit was completed by LPA Perry Scott on 02/23/24. LPAs investigated the allegations mentioned in this complaint; and conducted interviews with residents and staff. Staff rosters, Resident rosters, Needs and Service Plan, Physicians Report, Incontinent Records, and Medication list for R1and R2 were obtained from the facility. A tour of the facility was conducted.

The investigation revealed the following: Allegation-Facility staff did not dispense medication as prescribed.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
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 4
Control Number 11-AS-20230203151839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NP CARE HOME
FACILITY NUMBER: 198602263
VISIT DATE: 02/23/2024
NARRATIVE
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On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility staff members did not dispense residents (R1) medication as prescribed and waited a couple days before giving the medication to the resident. 3 of 3 staff denied the allegation that Facility staff did not dispense medication as prescribed. All staff (S1-S3) stated that they give the residents medication as prescribed. S1 stated that the prescription for R1 was a five-day prescription, and it was given to the resident as prescribed. LPA reviewed the Medication Administration Record and did not observe any discrepancies. LPA interviewed R2-R5 about the allegation that Facility staff did not dispense medication as prescribed. 4 of 4 residents denied the allegation and stated that they do receive their medication as prescribed.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff did not dispense medication as prescribed. 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.

Allegation # 2- Staff falsified records.

On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility falsified documents by putting different dates for medication in the Medication Administration Record for R1. 3 of 3 staff denied the allegation that the Staff falsified records. All staff (S1-S3) stated that they do not falsify documents and all medication given to the residents are documented. LPA verified the records and did not find any discrepancies. LPA interviewed R2-R5 about the allegation that the Staff falsified records. 4 of 4 residents denied the allegation and stated that they haven’t had any issues with their personal records.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff falsified records. 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.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230203151839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NP CARE HOME
FACILITY NUMBER: 198602263
VISIT DATE: 02/23/2024
NARRATIVE
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Allegation # 3- Staff did not assist resident with incontinence needs.

On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility left R1 in soiled clothing overnight and was not changed. 3 of 3 staff denied the allegation that Staff did not assist resident with incontinence needs. All staff (S1-S3) stated that all residents are incontinent and that they are checked on every two hours and are changed if needed. They deny that any resident has been neglected by not changing them when needed. LPA interviewed R2-R5 about the allegation that Staff did not assist resident with incontinence needs. 4 of 4 residents denied the allegation and stated that whenever they need to be changed the staff does indeed change them.

Based on interviews, there is insufficient evidence to support the allegation that the Staff did not assist resident with incontinence needs. 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.

Allegation # 4- Staff did not change resident's clothing.

On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer living at the facility. The details of the complaint alleged that the facility left R1 in soiled clothing overnight and was not changed. 3 of 3 staff denied the allegation that Staff did not change resident's clothing. All staff (S1-S3) stated that no one has ever told them that they were not changed and remained in soiled clothing. LPA interviewed R2-R5 about the allegation that Staff did not change resident's clothing. 4 of 4 residents denied the allegation and stated that the staff has never left them in soiled clothing.

Based on interviews, there is insufficient evidence to support the allegation that the Staff did not change residents’ clothing. 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.

Allegation # 5 Staff serve small portions of food to residents.

On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer at the facility. The details of the complaint alleged that the facility is serving small portions of food to the residents. 3 of 3 staff denied the allegation that Staff serve small portions of food to residents. All staff (S1-S3) stated that they do not serve small portions of food to the residents. They all state that they serve normal sized portions of food. LPA observed during lunchtime that the residents were served normal sized portions of food and seemed to be happy. LPA interviewed R2-R5 about the allegation that Staff serve small portions of food to residents. 4 of 4 residents denied the allegation and stated that they are being served enough food to eat and it is not small portions of food.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230203151839
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: NP CARE HOME
FACILITY NUMBER: 198602263
VISIT DATE: 02/23/2024
NARRATIVE
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Based on interviews and observation, there is insufficient evidence to support the allegation that the Staff serve small portions of food to residents. 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.

Allegation # 6- Facility does not purchase enough food for residents.

On 02/23/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S3) and residents (R2-R5) regarding the allegation. R1 is no longer at the facility. The details of the complaint alleged that the facility does not purchase enough food to feed the residents in the facility. 3 of 3 staff denied the allegation that Facility does not purchase enough food for residents. All staff (S1-S3) stated that the facility goes shopping weekly for the residents and they purchase enough to serve the residents. LPA toured the facility and observed that the facility has enough food to meet the needs of the residents. LPA interviewed R2-R5 about the allegation that Facility does not purchase enough food for residents. 4 of 4 residents denied the allegation and stated that the facility does have enough food to feed them, and they are satisfied.

Based on interviews and observation, there is insufficient evidence to support the allegation that the Facility does not purchase enough food for residents. 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.

No deficiencies were cited during this visit.

An exit interview was conducted, and a copy of this report was provided to Krystal Perkins, Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4