198602612-7-3-2024-11-AS-UCOL-D7AUDK-20240718152940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602612
Report Date: 07/03/2024
Date Signed: 07/03/2024 02:28:17 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
06/28/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240628094847

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:	09:21 AM
MET WITH:	STAFF MICHAEL SAUCEDO		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Licensee is retaliating against a resident for filing a complaint.
Wrongful eviction.

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-20240628094847

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: Licensee is retaliating against a resident for filing a complaint. It is being alleged that licensee is retaliating against a resident for filing a complaint. The interviews indicate: S1 indicates that the R2 family member was visiting and was in another resident’s room. S1 indicates that R2 family member was being disruptive and S1 asked for R2 family member to leave. S1 indicates that S1 called the police and the police never showed up. S1 indicates that no staff would retaliate against a resident or resident family member for filing a complaint. S1 indicates that words were exchanged between S1 and R2 family member and it was a simple communication problem. S1 indicates that R2 family member was allowed back into the facility after the incident happened on 06/23/2024. 3 out of 3 staff indicate that they have no knowledge of any staff retaliating against R2 or R2 family. 3 out of 3 staff indicate they have seen R2 family member inside the facility after 06/23/2024. R2 has cognitive issues and could not be interviewed. Reviewed incident report (date 6/23/2024), staff S1 indicates that on 06/23/2024 around 5:40pm R2 family member was causing a disturbance and was asked to leave the facility. Staff states that S1 called LAPD #3212 for trespass guest and R2 family member had left prior to police arriving at the facility. S1 requested for R2 to relocate if R2 family member could not be controlled.

Regarding Allegation #2: Wrongful eviction. It is being alleged the facility wrongfully gave eviction notice to R2 family. The interviews indicate: S1 indicates that the R2 family member was visiting and was in another resident’s room. S1 indicates that R2 family member was being disruptive and S1 asked for R2 family member to leave. S1 indicates that S1 called the police and the police never showed up. S1 indicates that there was a communication issue with R2 family member and at no time did the facility give written notice of eviction to R2 family member. S1 indicates that S1 advised all residents that the facility was closing, and the residents would have to move. W2 indicates that W2 spoke to S1 and confirms that no verbal or written eviction notice was given to R2 family member or W2. W2 indicates that S1 and R2 family member exchanged words on 06/23/2024 and there were no issues. R2 has cognitive issues and could not be interviewed. Reviewed R2 resident file and could not locate any written eviction notice.

Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Licensee is retaliating against a resident for filing a complaint” and “Wrongful eviction” 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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