198602620-7-12-2023-11-AS-SCIS-CW2SGW-20230926135236

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 07/12/2023
Date Signed: 07/12/2023 10:00:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
07/07/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230707140554

FACILITY NAME:	LONG BEACH RESIDENTIAL		FACILITY NUMBER:	198602620
ADMINISTRATOR:	CRYSTAL BARRIENTOS		FACILITY TYPE:	735
ADDRESS:	4201 EAST 10TH STREET		TELEPHONE:	(562) 433-2455
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	49	CENSUS: 47	DATE:	07/12/2023
		UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Crystal Barrientos		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident is being physically abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, July 07, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Assistant Administrator Crystal Barrientos. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews were conducted with staff 1-2 (S1-S2), witness 1 (W1), and residents 1-5 (R1-R5). S1-S2 and R1-R5 stated the allegation is false. None of the resident is being physically abused while in care. S1-S2, W1, and R1-R5 stated that they never witnessed any resident being abused at the facility. LPA Bunker requested and reviewed resident records and requested copies of staff and residents' roster, admission agreement, appraisal/needs and service plan, physician reports, I.D. and emergency information, progress notes, MAR, and St. Mary Medical Center-Long Beach discharge instructions document.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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-20230707140554

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 07/12/2023

NARRATIVE

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Continued LIC9099-C page 2

Allegation: Resident is being physically abused while in care. Staff 1-2 (S1-S2), witness (W1), and resident 1-5 (R1-R5) interviewed stated residents are treated with dignity and respect. S1-S2 stated the facility has a zero-tolerance policy. Physical abuse is not allowed. S1-S2, W1, and R1-R5 stated none of the residents got struck in the back of the head, nor did any resident get hit in the back of the head and slapped in the face while they were sleeping. S1-S2 and R1-R5 stated there was a resident residing at the facility that is no longer living at the facility that was delusional and hallucinating and would have loud outbursts, yelling, and screaming, saying someone hit her in the head when no one witnessed the incident. The facility staff took the necessary precaution and examined the resident for injuries or bruises. The resident had no injury. S1-S2, W1, and R1-R5 stated residents are provided with a safe, healthful, and comfortable environment. Residents are free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. S1-S2, W1, and R1-R5 denied the allegation.

Investigation revealed the following: Staff 1-2 (S1-2), witness 1 (W1), and residents 1-5 (R1-R5) interviewed stated no one witnessed any resident getting struck in the back of the head. S1-S2 stated as per the facility's policy, staff has expressed a strict zero tolerance towards physical abuse. It has been confirmed by staff and residents that no instances occurred where any residents were struck in the back of the head or subjected to being hit and slapped in the face while asleep. S1-S2 stated that no other residents reported any injuries or bruises resulting from any physical altercations. S1-S2 stated the facility is fully staffed and treats all residents with dignity and respect. S1-S2 stated residents are provided with the necessary care and supervision. S1-S2 stated if there was any physical abuse, they would have investigated the incident and reported it to all the appropriate agencies in a timely manner. S1-S2 and R1-R5 all denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.
A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Administrator Crystal Barrientos. There were no deficiencies cited. Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

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