198602614-9-12-2022-11-AS-MVAO-CJQPAU-20220929110917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602614
Report Date: 09/12/2022
Date Signed: 09/12/2022 03:19:06 PM

Unsubstantiated

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
08/10/2021 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210810113241

FACILITY NAME:	PRIME OPTIONS CARE INC		FACILITY NUMBER:	198602614
ADMINISTRATOR:	NGUYEN, HAI		FACILITY TYPE:	735
ADDRESS:	2041 W 162ND ST		TELEPHONE:	(310) 678-6784
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	5	CENSUS: 4	DATE:	09/12/2022
		UNANNOUNCED	TIME BEGAN:	02:47 PM
MET WITH:	Administrator - Joy Suarez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident sustained an unexplained injury while in care.
Staff threatened residents.
Staff not providing adequate food service.
Staff not meeting resident's toileting needs.
Facility has an odor.
Facility does not have sufficient supplies.

INVESTIGATION FINDINGS:

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On 09/12/2022 Licensing Program Analyst (LPA) Don Senaha initiated a subsequent complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Adminstrator Joy Suarez and the purpose of the visit was to deliver findings.

On 08/11/2021 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Hai Nguyen. On 03/22/2022 Licensing Program Analyst (LPA) Don Senaha initiated a subsequent complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Administrator Linda Whitford.
The investigation consisted of the following: LPA requested resident roster, staff roster and other service documents. LPA interviewed Staff (S1-S3) and Administrator Linda Whitford. A plant inspection of the facility was conducted.
There were no deficiencies found during any visits.
Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

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-20210810113241

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: PRIME OPTIONS CARE INC	FACILITY NUMBER: 198602614
	VISIT DATE: 09/12/2022

NARRATIVE

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Investigation revealed:

Allegation: Resident sustained an unexplained injury while in care.

During LPA investigation visits on August 11, 2021, February 23, 2022 and March 22, 2022, LPA observed client (C1) without injuries. LPA conducted interview with Administrator. Administrator stated that on August 9, 2021 staff reported discoloration around client’s (C1) right eye. Administrator stated that the cause of injury was unwitnessed. Administrator stated it is believed that client (C1) caused the discoloration around the right eye during a self-injurious behavioral episode. Administrator stated client (C1) has a behaviorist and a behavioral intervention plan in place. LPA obtained and reviewed behavior intervention plan on 06/08/2022. LPA conducted interview with neurologist (W3) and obtained documentation from neurologist (W3) dated August 12, 2021, stating client (C1) has history of self-injurious behaviors. LPA conducted an interview with client’s (C1) Conservator (W1) who stated that client (C1) does have a history of self-injurious behavioral episodes which has decreased since client (C1) has been residing at the facility since February 15, 2019. The Conservator (W1) stated the facility is provided client (C1) with necessary support and care and visits client (C1) on a weekly basis at the facility. LPA conducted interviews with staff (S1 and S3) who stated staff have observed client (C1) during behavioral episodes where client (C1) has attempted self-harm and during these episodes staff (S1 and S3) apply behavioral support interventions training. LPA obtained and reviewed staff intervention training for client (C1) on 05/20/2022.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210810113241

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: PRIME OPTIONS CARE INC	FACILITY NUMBER: 198602614
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation: Staff threatened residents.

During the course of the investigation, LPA did not observe staff threats to clients in care during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. LPA conducted interview with Administrator. Administrator made no observations and stated there are no reports of staff threatening clients in the facility. LPA interviewed staff (S1-S3) who stated staff have not treated clients inappropriately. Staff (S1-S3) stated staff have not observed any co-workers behaving inappropriately to clients. Staff (S1-S3) stated staff do not confine clients to their rooms. LPA observed clients in the living room area during visits on August 11, 2021, February 23, 2022 or March 22, 2022. LPA conducted interviews with family (W1-W2). Family (W1-W2) stated the staff has treated the clients appropriately and are supportive and have no concerns.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Allegation: Staff not providing adequate food service.

During the course of the investigation, LPA did observe a daily food menu on the refrigerator during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. LPA observed a sufficient amount of food available during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. Administrator and staff (S1-S3) stated clients are provided daily meals and snacks. Family (W1-W2) stated they have no concerns with the client’s needs being provided.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210810113241

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: PRIME OPTIONS CARE INC	FACILITY NUMBER: 198602614
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation: Staff not meeting resident’s toileting needs.

During the course of the investigation, LPA did not observe any odor in the facility or any clients requiring assistance with hygiene, bedding or changing of clothes during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. LPA conducted interviews with the Administrator and staff (S1-S3) who stated the clients who require assistance with hygiene and changing of clothing do not go unattended. Family (W1-W2) have no concerns or issues with client’s hygiene, bedding or changing of clothing being addressed at the facility.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Allegation: Facility has an odor.

During the course of the investigation, LPA did not observe any odor in the facility during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. Administrator stated Administrator has no concerns with any odor in the facility. Administrator stated staff clean the facility throughout the day. Staff (S1-S3) stated staff have no concerns with any odor in the facility. Staff (S1-S3) stated staff provide clients assistance with hygiene needs. Administrator and staff (S1-S3) stated the facility has changed the floors from carpet to wood floors in order to maintain a sanitary environment. LPA observed no issues with the wood floors.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20210810113241

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: PRIME OPTIONS CARE INC	FACILITY NUMBER: 198602614
	VISIT DATE: 09/12/2022

NARRATIVE

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Allegation: Facility does not have sufficient supplies.

During the course of the investigation, LPA did observe a sufficient supply of food in the facility during facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. LPA observed a sufficient amount of supplies in the office, stock room and garage during the facility visits on August 11, 2021, February 23, 2022 or March 22, 2022. Administrator stated there are no concerns with supplies at the facility. Administrator stated staff has no concerns with supplies at the facility. Staff (S1-S3) stated staff have no concerns with supplies at the facility.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support these allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Don Senaha
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022

LIC9099 (FAS) - (06/04)

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