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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603203
Report Date: 06/15/2023
Date Signed: 06/15/2023 09:24:53 AM

Substantiated


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
05/10/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230510151701
FACILITY NAME:CONGREGATE CONNECT - ARBUTUSFACILITY NUMBER:
198603203
ADMINISTRATOR:HERBERT LEEFACILITY TYPE:
735
ADDRESS:714 W ARBUTUS STREETTELEPHONE:
(213) 792-4414
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:4CENSUS: 4DATE:
06/15/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lorena PeraltaTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility is in disrepair
INVESTIGATION FINDINGS:
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On 06/15/2023, Licensing Program Analyst (LPA) Perry Scott conducted a continuation of a complaint visit that was done on 05/18/2023. LPA Scott met with Lorena Peralta, DSP and explained the purpose of this visit is to deliver findings from a previous complaint.

On 05/18/2023 Licensing Program Analyst (LPA) Perry Scott conducted a complaint investigation for the allegation(s) listed above. LPA Scott was met by DSP, Lorena Peralta, and later Herbert Lee, administrator, and explained the purpose of today’s visit was to gather information regarding the complaint allegations.

On 05/18/2023, the investigation consisted of the following:

LPA Scott conducted a tour of the facility. While touring the facility, LPA checked both bathrooms for leaks and signs of flooding. LPA was assisted by the DSP, she ran the water for a while for the first bathroom, and it did not drain properly. The other bathroom did not have any draining issues. LPA toured all bedrooms and found that one of the bedrooms had floorboards that were in disrepair. The floorboards were lifting from the floor, as if they had water damage. All other bedrooms were within title 22 regulations. LPA also checked that the facility had enough perishable and non-perishable food for the facility. LPA observed that the facility had a sufficient supply to serve the clients. LPA obtained the following files from the facility: Face sheets for all clients, resident roster, and P & I ledgers.

Report continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
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 5
Control Number 11-AS-20230510151701
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: CONGREGATE CONNECT - ARBUTUS
FACILITY NUMBER: 198603203
VISIT DATE: 06/15/2023
NARRATIVE
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The investigation revealed the following: Regarding allegation #1: Facility is in disrepair

On 05/18/23, LPA interviewed S1-S3. 3 of 3 staff confirmed that one of the facilities bathrooms has a plumbing issue, in that the drain in the bathtub, after taking a shower, does not drain well, floods, and leaks into the residents’ bedroom causing floor damage. All staff say that it has been an ongoing issue for a while, S1 states that the Regional Center knows about the issue and are working to resolve it. Additionally, S1 stated that the residents were made aware that they were to use the other bathroom in the facility until the plumbing issue is fixed.

On 05/18/23, LPA interviewed R1-R3 about the leak in the bathroom, and 3 of 3 residents confirmed that the bathroom has leakage and drainage problems. All stated that the administrator advised them not to use that bathroom until the issue with the plumbing is resolved. They were instructed to use the other bathroom to take baths and showers.

On 05/18/23, Licensing Program Analyst (LPA) Perry Scott conducted an inspection of the facility and observed that when the shower ran in the restroom it did not drain and started to flood the restroom. Additionally, LPA observed water damage on the floorboards of the room and in the closet area.

Based on LPA’s observation and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation: Facility is in disrepair, are found to be substantiated. California Code of Regulations, Title 22, Division (6) and chapter (1) are being cited on the attached LIC 9099D.

An exit interview was conducted. Plans of corrections were developed. A copy of this report and appeal rights were given to Lorena Peralta, DSP.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20230510151701
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: CONGREGATE CONNECT - ARBUTUS
FACILITY NUMBER: 198603203
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees, and visitors. This requirement is not met as evidenced by:
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Administrator will coordinate with the regional center to repair the floorboards as well as fix all plumbing issues in the bathroom so that it drains properly. The administrator will submit documentation verifying that repair orders are in process or completed by the POC due date of 06/29/2023 and email the documents to perry.scott@dss.ca.gov.
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Based on interviews and observations LPA confirmed that there is a water leak and a drainage problem in one of the bathrooms. This leak has damaged the floorboards in one of the residents’ rooms causing the floorboards to “lift up” from the floor which poses a potential health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/10/2023 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230510151701

FACILITY NAME:CONGREGATE CONNECT - ARBUTUSFACILITY NUMBER:
198603203
ADMINISTRATOR:HERBERT LEEFACILITY TYPE:
735
ADDRESS:714 W ARBUTUS STREETTELEPHONE:
(213) 792-4414
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY:4CENSUS: 4DATE:
06/15/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:TIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is withholding residents P&I funds.
INVESTIGATION FINDINGS:
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On 06/15/2023, Licensing Program Analyst (LPA) Perry Scott conducted a continuation of a complaint visit that was done on 05/18/2023. LPA Scott met with Lorena Peralta, DSP and explained the purpose of this visit is to deliver findings from a previous complaint.

On 05/18/2023 Licensing Program Analyst (LPA) Perry Scott conducted a complaint investigation for the allegation(s) listed above. LPA Scott was met by DSP, Lorena Peralta, and later Herbert Lee, administrator, and explained the purpose of today’s visit was to gather information regarding the complaint allegations.

On 05/18/2023, the investigation consisted of the following:

LPA Scott conducted a tour of the facility. While touring the facility, LPA checked both bathrooms for leaks and signs of flooding. LPA was assisted by the DSP, she ran the water for a while, and it did not drain properly. The other bathroom did not have any draining issues. LPA toured all bedrooms and found that one of the bedrooms had floorboards that were in disrepair. The floorboards were lifting from the floor, as if they had water damage. All other bedrooms were within title 22 regulations. LPA also checked that the facility had enough perishable and non-perishable food for the facility. LPA observed that the facility had a sufficient supply to serve the clients. LPA obtained the following files from the facility: Face sheets for all clients, resident roster, and P & I ledgers.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20230510151701
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: CONGREGATE CONNECT - ARBUTUS
FACILITY NUMBER: 198603203
VISIT DATE: 06/15/2023
NARRATIVE
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The investigation revealed the following: Regarding allegation #2 Facility is withholding residents P&I funds.

On 05/18/23, LPA interviewed staff (S1-S3). 3 of 3 staff denied the allegation that the Facility is withholding residents P&I funds. All staff stated that all of the residents are receiving their P& I money. The residents receive their money every two weeks according to all staff. LPA reviewed the P & I ledger and cash on hand and verified that each resident R1-R3 had a reserve of $624.00 for each. Additionally, LPA interviewed residents (R1-R3) and each resident verified that they are getting their money every two weeks as stated by S1-S3.

Based on interviews, observations, and a records review there is insufficient evidence to support the allegation: Facility is withholding residents P&I funds. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview has been conducted and a copy of the Complaint Report was provided to Lorena Peralta, DSP.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5