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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603346
Report Date: 10/07/2022
Date Signed: 10/07/2022 06:15:47 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
06/28/2022 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220628114815
FACILITY NAME:MARROQUIN 51ST PLACEFACILITY NUMBER:
198603346
ADMINISTRATOR:MARROQUIN, YOSMANFACILITY TYPE:
735
ADDRESS:1140 W. 51ST STREETTELEPHONE:
(213) 509-4397
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:4CENSUS: 3DATE:
10/07/2022
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Lydia McClainTIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Resident is not being adequately fed while in care.
Resident is not allowed to go out of the facility for rides and walks.
Staff member did not fulfill reporting requirements.
Staff members inappropriately handled resident while in care.
Staff do not treat resident in a dignified and respectful manner.
INVESTIGATION FINDINGS:
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On 10/07/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit at this facility. LPA Dabuet was greeted by licensed psychiatric technician Lydia McClain. McClain contacted licensee and administrator Yosman Marroquin by telephone and was able to join the team. LPA Dabuet met with the administrator and explained the purpose of today's visit.

The investigation included the following; A review of the Client roster, Staff roster, Face sheets, ID/Emergency, Individual Personal Plan, Medication Administration Records, and other pertinent documents associated with client #1 (C1). Interviews were conducted with clients #1- #4 (C1-C4) and staff #1 - #4 (S1-S4) and witness #1 (W1). A plant inspection of the entire facility on 07/07/22 and 10/07/22.

Evaluation Report continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
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-20220628114815
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: MARROQUIN 51ST PLACE
FACILITY NUMBER: 198603346
VISIT DATE: 10/07/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Resident is not being adequately fed while in care.

The details of the complaint alleged that client #1 (C1) is not adequately fed while in care. The reporting party claims the food is withheld from (C1) when requested. An interview with (C1) states she receives a fair amount of food. She is served three meals and three snacks daily. (C1) states no staff withholds or prevents her from having seconds on meals or access to snacks. Interviews with clients #2 and #4 (C2-C4) both confirmed the facility provides several meals and snacks daily and has access to the food supply. Interviews with staff #1- #4 reported there are no issues with clients accessing food at this facility. No clients are refused or prevented from having access to the food supply. The Department inspected the food supply on 07/07/22 and 10/07/22 a found the facility is within Title 22 regulations. There is sufficient perishable and non-perishable food along with an emergency ration supply. Based on the information gathered, there is no evidence to support the allegation mentioned above.



Allegation: Resident is not allowed to go out of the facility for rides and walks.

The complainant states client #1 (C1) is not allowed out of the facility for rides and walks. The complainant was unable to provide additional details on this allegation. An interview with (C1) claims she can have her time and space alone. The staff allows her to have activities outside of the home. She goes on unrestricted rides or walks with staff. (C1) claims she has no issues with any of the staff. Interviews with (C2) and (C4) both repeated the same sentiments that they have the freedom for unrestricted activities and outings. Clients are allowed to go on outings as part of daily activities reported by staff #1- #4 (S1-S4). As far as clients are concerned, there have been no issues. The Department observed during investigation visits on 07/07/22 and 10/07/22, the clients were escorted to outside activities. Based on the information gathered, there is no evidence to support the allegation mentioned above.



Allegation: Staff member did not fulfill reporting requirements.

It is alleged that the facility failed to report incidents involving client #1 (C1). An interview with (C1) states she feels comfort and safe living at this home. She does not want to live anywhere else and staff provides her with proper care.


Evaluation Report continues on LIC 9099-C
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20220628114815
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: MARROQUIN 51ST PLACE
FACILITY NUMBER: 198603346
VISIT DATE: 10/07/2022
NARRATIVE
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An interview with regional service coordinator witness #1 (W1) states the facility maintains in communication with South Central Los Angeles Regional Center with telephone calls and incident reports . An interview with staff #1-#4 (S1-S4), we are mandated reporters and have a duty to report and notify agencies such as Community Care Licensing (CCLD), South Central Los Angeles Regional Center (SCLARC), Adult Protective Services (APS) and law enforcement. As a result of a review of service records for clients #1-#4, the Department found written records, including Unusual Incident/Injury Reports LIC 624 for each client. Based on the information gathered, there is no evidence to support the allegation mentioned above.

Allegation: Staff members inappropriately handled resident while in care.
Staff do not treat resident in a dignified and respectful manner.

The details on this complaint allege client #1 (C1) was mishandled by staff #3 (S3) inappropriately while in care. In addition, the complainant alleged the staff does not treat all the clients in a dignified and respectful manner. In an interview with the complainant, she claims she only heard from (C1) that she was mistreated by (S3). The complainant did not witness the incident as reported by (C1). The complainant states the staff not treating the clients in respectful manner is reported by another witness and did not have the name. An interview with (C1) disputes these allegations. (C1) claims she is not mistreated by (S3) or any other staff. She has not been inappropriately mishandled by (S3) or by any other staff. (C1) claims she has no improper behavior with any staff. (C1) states she gets along with all the staff and they are “cool”. An interview with staff #1-#4 (S1-S4) claims there have been some incidents associated with (C1) and all have been documented and reported to the proper agencies. According to (S1-S4) there have been no mistreatment from any of the staff to any of the clients. Clients #2 (C2) and #4 (C4) also communicated the same feelings of respect and dignity as client #1 (C1). South Central Los Angeles Regional Center (SCLARC) conducted its investigation and found no evidence to support these allegations. An assignment Community Care Licensing (CCL) Investigation Branch interviewed the clients and found no evidence of mistreatment or improper behavior from staff. As client #3 (C3) is not available and is detained, he was not interviewed. Based on the information gathered, there is no evidence to corroborate these allegations mentioned above.

Evaluation Report continues on LIC 9099-C
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20220628114815
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: MARROQUIN 51ST PLACE
FACILITY NUMBER: 198603346
VISIT DATE: 10/07/2022
NARRATIVE
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Based on information gathered, an inspection of the facility, observation, analysis of (C1)'s service records and other reports associated with this complaint, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint.

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 Lydia McClain, and a copy of the report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand DabuetTELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4