198602883-2-9-2023-11-AS-JHAD-CPJQGE-20230302110921

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602883
Report Date: 02/09/2023
Date Signed: 02/09/2023 05:41:08 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
02/03/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230203102357

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:	02/09/2023
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	April Gorman		TIME COMPLETED:	04:59 PM

ALLEGATION(S):

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Resident is verbally abusive towards another resident in care.
Resident is bullied by another resident in care.
Resident does not have access to the facility phone.
Resident is denied food.
Resident was required to clean up another resident's feces.
Facility not allowing resident to participate in activities.
Facility not allowing resident to attend outings.

INVESTIGATION FINDINGS:

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On 02/09/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit. Upon arrival at the facility. LPA verified in person of COVID-19 activity. Based on the assessment, the facility is cleared of COVID-19 infection. LPA met with Administrator April Gorman. LPA explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed staff #1-#3 (S1-S3) client #1-#4 (C1-C4) and witness #1 (W1). LPA asked questions relevant to the nature of the complaint. A toured the facility inside to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. Service records for (C1-C2) were provided and were reviewed.

Evaluation Report continues LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 11-AS-20230203102357

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: 02/09/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident is denied food.
It is alleged that client #1 (C1) is denied food by staff at this facility. The complainant reported (C1) is denied snacks when requested. The complainant did not have the name of the staff involved and did not have further details. According to (C1's) physician's report dated 06/13/22, (C1) is diabetic and required assistance from staff on the special diet. An interview with (C1) disputes this allegation. (C1) states she receives three meals and three snacks daily. Often she will refuse snacks or meals, as (C1) wants to portion her meals to lose weight. (C1) claimed there is too much food and there is enough go around. (C1) claimed she has never been denied food and has daily access to food in the kitchen. Interview with clients #2-#3 (C2-C3) both dispute this allegation. (C2-C3) expressed that meals and snacks are available at their disposal daily. Staff #1-#3 (S1-S3) described that all clients have access to food and received three meals and three snacks daily. (S1-S3) claimed the clients often will make their meals or snacks and have never been denied to having access to the food pantry or supplies. (S1-S3) claimed the staff will monitor (C1's) meals and snacks as (C1) is diabetic and on a special diet. A sample menu was provided and it indicated Breakfast at 6:30 am; AM snack at 10 am, Lunch at noon, a PM snack at 3:30 pm, Dinner at 5:30 pm, and an Evening snack at 7:30pm. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above.

Allegation: Resident does not have access to the facility phone.
The details of the complaint stated that client #1 (C1) does not have access to the facility phone. The complainant states on 02/04/23 that incoming calls automatically go directly to fax. The complainant stated she was informed by administrator staff #1(S1) the phone was specifically broken on that day no one had access to the phone. Interview with (S1) disputes this allegation. (S1) stated the phone has been operating properly and never has been disconnected for non-payment or needing repair. (S1-S2) the facility phone and fax machine use the same line. Adding a fax machine to a phone line means there are some limitations to the abilities of the phone line when the fax is being used and must be manually switched to regular phone mode. (S1-S3) and clients (C1-C3) confirmed that the facility phone was always functional and has never been an issue. The Department observed a working landline telephone during the visit. Based on the information gathered, there is insufficient evidence to support the allegation mentioned above.

Evaluation Report continue LIC 9099

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20230203102357

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: 02/09/2023

NARRATIVE

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Allegation: Resident was required to clean up another resident's feces.
The complainant stated there had been an incident when client #1 (C1) was ordered by staff to clean up another client's feces. The complainant reported that (C1) was ordered by staff to clean up feces in the bathroom from another roommate. The complainant was uncertain of the date and time of the occurrence nor had a name of staff or witness involved. According to (S1-S3) the clients have structured goals and objectives and one of them is domestic chores per day. Even though the clients will assist with household chores, they have never been told harshly or aggressively that they would be forced to do something they do not desire. After being questioned about this incident, (C1) was unable to confirm its existence. (C2-C3) unable to confirm if this incident had happened. Based on the information gathered, there is insufficient evidence to corroborate the allegation mentioned above.

Allegation: Facility not allowing resident to participate in activities.
Facility not allowing resident to attend outings.
It is alleged that client #1 (C1) is not allowed to participate in activities nor attend outings. According to the complainant, these allegations are not directed at the facility, but rather at the day program that (C1) attends. The complainant stated there were no activities provided that are suited to keep (C1's) interest as these activities are being conducted in a virtual format. (S1-S3) describes since the COVID-19 pandemic day programs have been operating the day program activities through virtual formats. ( S1-S3) reported that the facility is searching for programs that will meet (C1)'s interest in-person activities. In an interview with (C1), (C1) stated that art and crafts, board games, exercise, music, and television keep her busy at home. (C1's) stated she will often participate in outings to the mall, beach, and shopping. (C2-C3) verified that the facility offers adequate activities and outings. Based on the information gathered, there is insufficient evidence to corroborate the allegation mentioned above.

Allegation: Resident is verbally abusive towards another resident in care.
Resident is bullied by another resident in care.
The details of the complaint stated client #1(C1) is verbally abused and bullied by client #2 (C2). The complainant stated that (C1) has been yelled at and spoken to unkindly and bullied by (C2) and nobody has corrected this behavior. An interview with (C2) denies these allegations. (C2) claimed they are like sisters and they lived together for four years at this home.

Evaluation Report continues LIC 9099

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20230203102357

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: 02/09/2023

NARRATIVE

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There have been no verbal altercations or aggressive behaviors towards (C1). An interview with (C1) claimed she is verbally abused and bullied by (C2). However, (C1) is unable to provide dates, times, or witnesses when these incidents occurred. (C1) is unable to describe how she is bullied by (C2). (C1) can only account for being bullied by stating, "I do not like it when she tells me what to do." According to (S1-S3) there have been no incidents between the two that would be considered hostile to one another. According to client #3 (C3), everyone seems to get along at this home.

During an interview with the complainant, the complainant reported staff did prevent an adult from causing harm to clients while in care and asked for the Department to investigate this matter. This matter was already addressed in complaint Control Number 11-AS-20230201112909 dated 02/07/23.

This issue had nothing to do with the staff working at the facility. The facility staff took additional measures and implemented a plan to handle this situation to prevent this type of incident from happening again in the future. (S1-S2) self-reported the allegation to Community Care Licensing Division, Harbor Regional Center, Adult Protective Services, Long Term Care Ombudsman, and Long Beach Police Department, all the appropriate agencies were notified promptly. The Department found the allegation to be unsubstantiated.

Client #4 (C4) who was present at the facility was unable to hold a conversation as a result of her disability.

Based on the information provided, the Department finds the facility is not in violation of Title 22 Regulations and no evidence supports the allegations mentioned above.

Although the allegations 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.

No deficiencies were cited during this visit.

An exit interview was conducted with April Gorman, and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023

LIC9099 (FAS) - (06/04)

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