198602620-9-1-2022-11-AS-JHAD-CJJNC3-20220923102003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 08/31/2022
Date Signed: 09/01/2022 08:54:42 AM

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
08/30/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220830161954

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: 48	DATE:	08/31/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Crystal Barrientos, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff failed to treat resident with dignity and respect
Staff member mismanages resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the above allegations. Today’s complaint investigation was conducted with Crystal Barrientos, Administrator, and the purpose of the visit was explained.

The investigation consisted of following: Interviews and Record reviews. On 08/31/22, LPA Soto interviewed Crystal Barrientos- Administrator, S#2 – S#4, C#1 – C#7. LPA toured lobby, office, and 2nd flr. dining room. LPA Soto received the following documents on 08/31/22: Resident Roster, Staff Schedule, ID and Emergency Information, Mars (August 2022,) Physician's report, Admission Agreement, Progress Notes, and Appraisal/Needs and Services Plan.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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-20220830161954

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: 08/31/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following:

Allegation 1 – Staff failed to treat resident with dignity and respect. Interviews with Administrator and staff agreed that they are not rude or disrespectful to any client. The clients are all treated with respect and kindness. C#1 begins to have behaviors when C#1 doesn’t get what he wants. He will begin cursing and yelling at staff. Interviews with C#2 – C#7, all agreed that the staff is always nice to them. Staff are never rude to them. Clients have not witnessed any staff be mean or rude to any other client. LPA reviewed C#1 file, C#1 has Mental Disabilities (Bipolar 1 Disorder) that may cause C#1 to become aggressive and abusive. LPA reviewed progress notes for C#1, C#1 will go at bedtime for C#1 bedtime medication and demand for C#1 morning medication to be given with bedtime medication. When staff refuses to give all C#1 medication at one time, C#1 will begin yelling and cursing staff and claim staff doesn’t like C#1. The interviews and records reviewed did not concur with the above allegation.

Allegation 2 - Staff member mismanages resident's medication. Interviews with Administrator and staff all agree that the clients always get their medication on time. If the clients don’t come to the office to get them, the staff will go to their rooms to remind them to go to the office to get the medication. Administrator, Staff #3, & #4, all agree that C#1 most of time, does not come to get C#1 morning medication. C#1 will come at bedtime and demand that C#1 morning medication be given to C#1 with C#1 bedtime medication. Staff will not give morning medication to C#1 and that’s when C#1 will begin yelling and cursing staff and get really upset. C#1 always goes and get C#1 PRN’s but never his morning medication. LPA reviewed C#1 Mars and Medical progress notes, C#1 refuses to go to office in the morning and get his morning mediation. C#1 will go get C#1 bedtime medication and PRN’s but will not go get or take his prescribed medication from doctor. C#1 is reminded to get medication and medication is ready as prescribed by doctor. Interviews and records reviewed did not concur with the above allegation.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

An interview was conducted with Crystal Barrientos, Administrator, and a hard copy of report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ana Soto
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC9099 (FAS) - (06/04)

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