198602612-7-3-2024-11-AS-UCOL-D7ATD4-20240718143741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602612
Report Date: 07/03/2024
Date Signed: 07/03/2024 02:35:31 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
06/24/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240624090031

FACILITY NAME:	LUCERNE ONE LLC		FACILITY NUMBER:	198602612
ADMINISTRATOR:	ESTELLE LEWIS		FACILITY TYPE:	740
ADDRESS:	11235 & 11237 LUCERNE AVE		TELEPHONE:	(310) 390-8181
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90230
CAPACITY:	15	CENSUS: 11	DATE:	07/03/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	STAFF MICHAEL SAUCEDO		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents are not receiving basic services
Facility personal are not sufficient in numbers

INVESTIGATION FINDINGS:

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On 07/03/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Lucerne One LLC and was greeted by Staff Michael Saucedo S1. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following: LPA Calderon interviewed staff S1-S4 and interview clients R1-R5. LPA Calderon interviewed W1-W2. On 07/03/2024 LPA Calderon obtained and reviewed the following: Incident report (date 06/23/2024), Admission agreement (date 08/22/2019) for R2, Physician Report (date 11/24/2023) for R2.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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-20240624090031

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: LUCERNE ONE LLC	FACILITY NUMBER: 198602612
	VISIT DATE: 07/03/2024

NARRATIVE

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Regarding Allegation #1: Residents are not receiving basic services. It is being alleged that staff did not provide basic services to residents in care. The interviews indicate: S1 indicates that the facility is being closed. S1 indicates that all services are being provided by staff to residents in care. S1 indicates that even though the facility is being closed all services are being provided to residents in care. 3 out of 3 staff indicate that staff do provide basic services to residents in care. 3 out of 5 residents indicate that staff does take care of their needs. 2 out of 5 residents have cognitive issues and could not be interviewed. LPA Calderon toured the facility on 07/02/2023 and 07/03/2024. LPA Calderon noted residents having breakfast. Some residents were watching TV. LPA Calderon noted staff cleaning, cooking, and taking care of residents. LPA Calderon noted that staff are taking care of resident’s basic needs.

Regarding Allegation #2: Facility personal are not sufficient in numbers. It is being alleged facility personal are not sufficient to take care of residents. The interviews indicate: S1 indicates that the facility is being closed and long-time staff quit or were fired. S1 indicates that S1 hired temporary staff until more staff could be hired. S1 indicates that at no time was there not enough staff to take care of resident’s needs. S1 indicates that S1 rehired long time staff and most shifts there are 2 to 3 staff working per shift. 3 out of 3 staff indicate that there are no staffing issues and most work shifts there are 2 to 3 staff working for 11 residents. 3 out of 3 staff indicate that there was a minor staffing problem when staff quit, but S1 rehired staff and the staffing issue was corrected. 3 out of 5 residents indicate that there are enough staff to take care of their needs. 3 out of 5 residents indicate that long time staff had left for unknown reasons, and some returned. 2 out of 5 residents have cognitive issues and could not be interviewed. LPA Calderon toured the facility on 07/02/2024 and 07/03/2024 and LPA Calderon noted 4 staff working at facility. LPA Calderon noted sufficient staff to meet the resident’s needs.

Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Residents are not receiving basic services” and “Facility personal are not sufficient in numbers” is found to be UNSUBSTANTIATED.

A face-to-face meeting was conducted with Staff Michael Saucedo, and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC9099 (FAS) - (06/04)

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