198602620-8-22-2022-11-AS-MVAO-CJQQ3M-20220929114857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 08/22/2022
Date Signed: 08/22/2022 12:28:51 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
08/17/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220817090803

FACILITY NAME:	LONG BEACH RESIDENTIAL		FACILITY NUMBER:	198602620
ADMINISTRATOR:	BONZON, TED		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:	08/22/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	ADMINISTRATOR CRYSTAL BARRIENTOS		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff conducted unreasonable searches
Resident use illegal drugs on the premises
Resident is not receiving medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Long Beach Residential Facility on 08/22/2022 at around 10:00 AM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10 day visit on 08/22/2022 approximately around 10:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 08/22/2022 LPA Calderon interviewed W1 for complaint. On 08/22/2022 LPA Calderon requested copies of the following: Staff and Resident rosters, admission agreement, Needs and Service Plan, Physician Report for W1, MAR for R1-R5. On 08/22/2022 LPA Calderon interview R2-R6 for complaint. On 08/22/2022 LPA Calderon interviewed S2–S3 for complaint.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

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-20220817090803

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: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 08/22/2022

NARRATIVE

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Regarding Allegation #1: Staff conducted unreasonable searches. On 08/22/2022 LPA Calderon interviewed W1 who states that staff searches W1 room without W1 permission and W1 does not know why this happened. W1 states that W1 has been living at facility for 5 years and this is the first time a search has happened. On 08/22/2022 LPA Calderon interviewed R2-R6 who state that staff have never searched their room without permission. On 08/22/2022 LPA Calderon interviewed S1-S3 all state no searches have been done only cleaning the resident’s room. On 08/22/2022 LPA Calderon reviewed admission agreement for W1, there is no contract language for any searches of resident’s room.

Regarding Allegation #2: Resident use illegal drugs on the premises. On 08/22/2022 LPA Calderon interviewed W1 who states W1 made up the story of other residents using illegal drugs and W1 does not use or have used illegal drugs. On 08/22/2022 LPA Calderon interviewed R2-R6 all state to have no knowledge of any illegal use of drugs on the premises. On 08/22/2022 LPA Calderon interviewed S1-S3, staff S1-S2 state no illegal drugs use on the premises as far as they know, S3 would answer the question. On 08/22/2022 LPA Calderon reviewed the facility record for W1, there is no mention of any illegal drug use by W1 on the premises and no LIC624 regarding illegal drug use

Regarding Allegation #3: Resident is not receiving medication as prescribed: On 08/22/2022 LPA Calderon interviewed W1 who states that staff forgets or refuses to give W1 medication. W1 states that this has only happened 2 times in 5 years. On 08/22/2022 LPA Calderon interviewed R2-R6 who state that staff gives them the correct medication daily and they have no issues with staff. On 08/22/2022 LPA Calderon interviewed S1-S2 who state that resident is given their medication from the medication room on time and in the correct amount. S1-S2 state no resident is refused medication unless there is no doctor’s prescription. On 08/22/2022 LPA Calderon reviewed MAR for R1-R5, there were no gaps in treatment and staff were not late giving medication to residents.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of Staff conduct unreasonable searches, Resident use illegal drugs on the premises, Resident is not receiving medication as prescribed is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator (S1).

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2022

LIC9099 (FAS) - (06/04)

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