198602620-2-28-2024-11-AS-UCOL-D3RUT8-20240327155132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 02/28/2024
Date Signed: 02/28/2024 01:55:44 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
02/20/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20240220145603

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: 49	DATE:	02/28/2024
		UNANNOUNCED	TIME BEGAN:	08:07 AM
MET WITH:	Marinel Luna		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide adequate supervision, resulting in a resident wandering away from the facility.
Staff did not notify police of missing resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit on Wednesday, February 28, 2024. Upon arrival at the facility. LPA Richard met Administrator Marinel Luna. LPA Richard explained the purpose of today's visit.

The investigation consisted of the following:

LPA Richard interviewed staff members 1-4 (S1-S4) and residents 1-5 (R1-R5). LPA Richard asked questions relevant to the nature of the complaint. LPA Richard requested copies of supporting documents. Personnel report, Medication sheet, House rules, Admission agreement, Appraisal/Needs and Services Plan, Physician Report, Consent for emergency Medical Treatment, and Harbor-UCLA Medical Center Discharge Instructions.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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-20240220145603

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: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 02/28/2024

NARRATIVE

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Allegation: Staff did not provide adequate supervision, resulting in a resident wandering away from the facility.

The investigation revealed the following:
Licensing Program Analyst Richard interviewed staff members 1-4 (S1-S4) and residents 1-5 (R1-R5) During the interview staff had consistently affirmed that residents are under sufficient supervision and do not exhibit a tendency to wander away from the facility. (S1-S4) and (R1-R5) stated that this is not a gated or locked facility, and residents have their personal rights, including the ability to sign in and out as they choose. Staff members are aware of the residents' locations and activities. S1 stated regarding the incident involving HARBOR UCLA Medical Center it should be known that this facility is not a locked facility, and residents here have the right to leave the premises at their discretion. Therefore, staff have being very helpful talking to residents about where they are going, in keeping track of residents' whereabouts and firmly denied the allegations. Staff does not provide adequate supervision. LPA interviewed resident (R1-R5) stated that leaving the facility anytime is the rights that residents have. Resident can go anywhere they please, without letting staff know their whereabouts. Sometimes (R1-R5) don’t remember to sign-in or sign-out they just leave. The residents (R1-R5) stated that after they had breakfast they just leave and don’t come back until it’s time for curfew, which is 10:00PM.

Report continues LIC9099-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240220145603

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: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 02/28/2024

NARRATIVE

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Allegation: Staff did not notify police of missing resident.

The investigation revealed the following:

LPA Richard interviewed staff members 1-4 (S1-S4) about the allegation. During the interview staff S1 -S2 stated the reason they didn’t notify the police is because the person must be missing for twenty-four hours. On 02/18/2024, the facility received a phone call from the police asking if the facility had a missing resident R1. The name of the police stated was the wrong resident's name, but after talking to the resident at the Harbor UCLA Medical Center the housekeeper realized that it was one of our residents R1. The administrator indicated that the staff periodically checks the resident's room in the middle of the night to ensure the residents were present. On 02/18/2024 around noon, the police bring the resident R1 back to the facility. The staff stated that the residents 1-5 (R1-R5) always leaves the facility without signing in or signing out and R1 does not come back until late at night. We know after twenty-four hours, the facility would have to call the police and file a missing person report, but before we were able to do that, we received a phone call where the resident R1 was. The administrator stated that calling the police is not an issue for the facility; since it is an unlocked facility the residents can come and go.

Based on interviews, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated.

Exit interview conducted, and a copy of this report was provided to the administrator Marinel Luna.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC9099 (FAS) - (06/04)

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