198602883-1-25-2023-11-AS-SCIS-CPNQUZ-20230306112931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602883
Report Date: 01/25/2023
Date Signed: 01/25/2023 09:17:55 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
01/17/2023 and conducted by Evaluator Lourdes Montoya

COMPLAINT CONTROL NUMBER: 11-AS-20230117164933

FACILITY NAME:	SANDRA'S HOUSE LLC #3		FACILITY NUMBER:	198602883
ADMINISTRATOR:	BENSON, SANDRA		FACILITY TYPE:	735
ADDRESS:	1908 STEVELY AVE		TELEPHONE:	(562) 843-8522
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	4	CENSUS: 4	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	APRIL GORMAN/SANDRA BENSON		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Inadequate staffing to meet the needs of clients in care.
Staff lack training to meet the needs of clients in care.

INVESTIGATION FINDINGS:

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On 1/25/2023, Licensing Program Analysts (LPAs) Lourdes Montoya conducted an initial 10-day complaint visit at this facility to gather and deliver complaint investigation findings. LPA Montoya called and conducted a risk assessment with Administrator April Gorman who confirmed the facility is Covid-19 free. LPA met with Administrator April Gorman who assisted with the visit. Licensee Sandra Benson arrived later and joined the visit. The purpose of the visit was explained.

The investigation consisted of the following: LPA Montoya conducted a tour of the inside and outside grounds of the facility with Administrator April Gorman. LPA interviewed staff, clients and a witness. LPA requested and obtained a client roster, staff roster, all current clients’ Individual Person-Centered Plans (IPPs), a copy of facility’s Personnel Policies, staffs’ timesheet, staff training records and other pertinent records.

Report continued in LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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-20230117164933

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: SANDRA'S HOUSE LLC #3	FACILITY NUMBER: 198602883
	VISIT DATE: 01/25/2023

NARRATIVE

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INVESTIGATIONS REVEALED:

Allegation: Inadequate staffing to meet the needs of the clients in care.

It is alleged the facility has inadequate staffing to meet the needs of the residents in care. Based on review of facility’s “Plan of Operation, there will always be at least one staff on duty when consumers are present in the home – 24 hours a day, 7 days a week”. Based on clients’ Individual Person-Centered Plans (IPP), C1 is ambulatory and independent with all of activities of daily living (ADLs); C2 is ambulatory and only requires reminders of ADL’s; C3 is non-ambulatory and requires some assistance with ADL’s and C4 is ambulatory and able to complete most ADL’s with minimal assistance and prompting. Interviews conducted with four staff (S1-S4), four clients (C1-C4) and a witness (W1) revealed there is adequate staffing to meet the needs of clients in care. Review of staff time sheets indicates there is always one to two staff providing care and supervision to clients in the home.

Allegation: Staff lack training to meet the needs of clients in care.

It is alleged staff lack training to meet the needs of clients in care. Based on LPA’s reviews, active staff have training records on file. Interviews conducted with four staff (S1-S4), four clients (C1-C4) and a witness (W1), staff are trained to meet the needs of clients in care.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Licensee Sandra Benson and a hard copy was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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