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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603320
Report Date: 09/24/2024
Date Signed: 09/24/2024 11:08:14 AM

Substantiated


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
09/17/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240917083849
FACILITY NAME:TOP CHOICE HOMESFACILITY NUMBER:
198603320
ADMINISTRATOR:HAYWOOD, MARSHAFACILITY TYPE:
735
ADDRESS:9134 ARMLEY AVE.TELEPHONE:
(626) 445-7100
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:6CENSUS: 6DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kenneth Cromm and Horace HallTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Client medication errors.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial complaint visit to investigate the above allegations. LPA was allowed entry by Kenneth Cromm and discussed the purpose of today's visit. LPA spoke to Marsha Haywood (via telephone) and discussed the purpose of today's visit. Horace Hall arrived at approximately at 9:40 A.M. and assisted with this visit.

During this visit, LPA obtained a copy of the staff and client rosters. LPA reviewed C-1's file and obtained relevant documentation. LPA also reviewed the Corrective Action Plan (CAP) addressing the above allegations issued by Eastern Los Angeles Regional Center dated September 6, 2024 with Marsha Haywood (Administrator) via telephone. Per Ms. Haywood, she is in agreement with the CAP findings and will be complying with the CAP.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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 28-AS-20240917083849
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: TOP CHOICE HOMES
FACILITY NUMBER: 198603320
VISIT DATE: 09/24/2024
NARRATIVE
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Allegation: Client medication errors. It has been alleged that a medication error occurred for Client #1 (C-1). Per issued Corrective Action Plan (CAP), for C-1, "Lorazepam 2mg PRN popped from the bubble pack on 4 and 23. Acetaminophen 500mg popped from bubble pack on 23. No indication on MAR within what timeframe period". LPA confirmed above information with Ms.Haywood (Administrator) via telephone. Per Ms. Haywood, she is in agreement with the CAP findings and will be complying with the CAP. Per CAP report and Ms. Haywood's agreement, this corroborates this allegation.

Based on interviews conducted and document review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiency is being cited according to California Code of Regulations, Title 22. Refer to LIC 9099D.

Exit interview conducted, appeal rights and this report was provided to Horace Hall.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20240917083849
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: TOP CHOICE HOMES
FACILITY NUMBER: 198603320
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/01/2024
Section Cited
CCR
80075(6)(C)
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Health Related Services (6) If the client is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the client with self-
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Administrator to conduct a staff training on medication administration (including documentation) and provide proof of training to LPA Irra by POC due date.
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administration, provided all of the following requirements are met: (C) The date and time the PRN medication was taken, the dosage taken, and the client's response, shall be documented and maintained in the client's facility record. This standard is not met as evidence by: C-1’s "Lorazepam 2mg PRN popped from the bubble pack on 4 and 23. Acetaminophen 500mg popped from bubble pack on 23. No indication on MAR within what timeframe period".
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CCR
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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.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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
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
09/17/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240917083849

FACILITY NAME:TOP CHOICE HOMESFACILITY NUMBER:
198603320
ADMINISTRATOR:HAYWOOD, MARSHAFACILITY TYPE:
735
ADDRESS:9134 ARMLEY AVE.TELEPHONE:
(626) 445-7100
CITY:WHITTIERSTATE: CAZIP CODE:
90603
CAPACITY:6CENSUS: 6DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Kenneth Cromm and Horace HallTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility is not meeting the clients' needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial complaint visit to investigate the above allegations. LPA was allowed entry by Kenneth Cromm and discussed the purpose of today's visit. LPA spoke to Marsha Haywood (via telephone) and discussed the purpose of today's visit. Horace Hall arrived at approximately at 9:40 A.M. and assisted with this visit.

During this visit, LPA obtained a copy of the staff and client rosters. LPA reviewed this facility's plan of operation/program design pertaining to Behavioral Consultant Program Guidelines and invoices for services rendered to all clients from the Behavior Consultant for April 2024 through August 2024. LPA reviewed this information with Horace Hall.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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 28-AS-20240917083849
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: TOP CHOICE HOMES
FACILITY NUMBER: 198603320
VISIT DATE: 09/24/2024
NARRATIVE
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Allegation: Facility is not meeting the clients' needs. It has been alleged that "there were no sign in sheet or documents to ensure the appropriate hours are being provided to each individual residing at the facility of behavior consultant hours". LPA reviewed this facility's plan of operation/program design pertaining to Behavioral Consultant Program Guidelines and invoices for services rendered to all clients from the Behavior Consultant for April 2024 through August 2024. Per the approved plan of operation/program design, the facility is to provide "no less than (2.7) hours of consultation per consumer per month in the area of behavior management". Per Behavioral Consultant invoices, the behavior consultant is providing (19) hours of services per month for the clients at this facility (3.17 hours per client per month). Per documentation reviewed, this allegation is not corroborated.

Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.



Exit interview was conducted and a copy of this report and appeal rights were provided to Horace Hall.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5