198603180-7-28-2023-28-AS-RORN-CUCLT2-20230803090138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603180
Report Date: 07/28/2023
Date Signed: 07/28/2023 11:13:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220106115108

FACILITY NAME:	RAECHELLE CARE HOME		FACILITY NUMBER:	198603180
ADMINISTRATOR:	BERG, TIA		FACILITY TYPE:	735
ADDRESS:	2215 W 15TH ST		TELEPHONE:	(323) 656-8266
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90006
CAPACITY:	30	CENSUS: 30	DATE:	07/28/2023
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Tia Berg - Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility abandoned resident

INVESTIGATION FINDINGS:

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LPA Erik Zaragoza conducted a subsequent complaint investigation regarding above stated allegation. LPA met with Administrator Tia Berg, and discussed the reason for the visit.

During the visit conducted on 01/14/2022, LPA Galarza obtained copies of staff roster, client roster, admission agreement, any SIRs regarding hospitalizations, and Progress notes. During today's visit LPA interviewed Administrator Tia Berg regarding the allegation that the facility had abandoned Client #1 (C1) at Huntington Hospital, and attempted to interview C1 however C1 is no longer a client at the facility and C1's whereabouts are unknown. LPA also gathered the following documents: Discharge paperwork from her previous facility, and administrator advised that she will be providing C1's pre-placement appraisal, her Needs and Services Plan, and her Physician's Report by email by the close of business day.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

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 28-AS-20220106115108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: RAECHELLE CARE HOME	FACILITY NUMBER: 198603180
	VISIT DATE: 07/28/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Facility abandoned resident", it is alleged that C1 was hospitalized due to contracting COVID on 12/26/2021, and the LCSW of the hospital advised the administrator that the isolation period for patients at their hospital is 10 days, and therefore would be released back to the facility on 1/5/2022. However the Administrator Tia explained that the patient cannot return that soon, and that their policy is that the patient can return after fourteen (14) days and that C1 can instead return on 1/9/2022 with a negative COVID test. During the interview with Tia, she explained that she worked in conjunction with a nurse from the Los Angeles County Department of Health Services as part of their Disease Control Team, and that they were strict on their 14-day policy because it was a high priority for the facility to not allow COVID to spread within the facility. It is also alleged that the facility did not accept C1 back because she had not paid any rent up to that point, and Tia explained that that is not true, that clients sometimes go three (3) months without paying rent and that they do not evict them nor do they not allow them to return to the facility for that reason. Tia additionally explained that she held a bed for C1, however when calling the hospital back to get an update on C1, the hospital stated that C1 was no longer present at the hospital and that C1 left on her own against medical advice because she was still in the middle of being quarantined for COVID. During the previous complaint visit, 6 out of 6 clients could not corroborate the allegation that the facility has abandoned clients at a hospital or any other location or facility, and 2 out of 2 staff interviewed could not corroborate the allegation either. LPA attempted to obtain additional information throughout the investigation, however calls were not returned. .

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023

LIC9099 (FAS) - (06/04)

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