198603221-12-28-2022-11-AS-MVAO-CN7SDB-20230118124651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603221
Report Date: 12/28/2022
Date Signed: 12/28/2022 02:53:54 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
12/23/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221223104634

FACILITY NAME:	SAVING GRACE ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	198603221
ADMINISTRATOR:	DANTZLER, GLENDA J		FACILITY TYPE:	735
ADDRESS:	2023 CULLIVAN STREET		TELEPHONE:	(323) 770-4501
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90047
CAPACITY:	4	CENSUS: 2	DATE:	12/28/2022
		UNANNOUNCED	TIME BEGAN:	12:00 AM
MET WITH:	Glenda Dantzler		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff did not assist resident with using the bathroom.
Facility staff did not treat resident with dignity.

INVESTIGATION FINDINGS:

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On 12/28/22 at 12:00pm, Licensing Program Analyst (LPA) Perry Scott and Licensing Program Manager (LPM) Janae Hammond initiated a complaint investigation regarding the allegations above. We were met by Glenda Dantzler, administrator, and the purpose of the visit was explained.

The investigation consisted of the following:

On 12/28/2022 at 12:15pm, we interviewed the administrator staff 1 (S1) and staff 2. LPA obtained copies of Resident/Staff rosters, Admission Agreement, Individual Program Plan, Physician report, Face sheet, and Health clearance. On 12/28/22 at 12:40pm, LPA conducted interviews with resident 1. LPA attempted to interview resident number 2 but (R2) was non-verbal.

The investigation revealed the following: Allegation 1: Facility staff did not assist resident with using the bathroom.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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-20221223104634

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: SAVING GRACE ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 198603221
	VISIT DATE: 12/28/2022

NARRATIVE

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LPA interviewed Glenda Dantzler, the administrator, about the allegation. She stated that both residents could use the bathroom by themselves and did not need assistance.

LPA interviewed staff 2 about the allegation and S2 denied the allegation.

On 12/28/22, LPA reviewed R1 and R2 records and the review of the records revealed that both residents did not require assistance in using the bathroom according to the physician’s report.

Allegation 2: Facility staff did not treat resident with dignity.

It was alleged that facility staff hosed down R1 in the backyard because R1 defecated on herself. The administrator and staff 2 denied the allegation.

LPA interviewed R1 and R1 indicated that R1 did not have any issues with the staff or the administrator. And that R1 was taken care of very well by everyone.

Based on interviews, observations, and records review there was insufficient evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

An exit interview was conducted with Glenda Dantzler, Administrator, and a copy of the report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC9099 (FAS) - (06/04)

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