198603426-8-17-2023-28-AS-RORN-CV8RSG-20230831131642

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603426
Report Date: 08/17/2023
Date Signed: 08/17/2023 01:23:56 PM

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
06/22/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220622082234

FACILITY NAME:	J AND C HOUSE OF LOVE II		FACILITY NUMBER:	198603426
ADMINISTRATOR:	SMITH, CHANTE		FACILITY TYPE:	740
ADDRESS:	15218 WILDER AVENUE		TELEPHONE:	(562) 706-2128
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	6	CENSUS: 6	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	09:18 AM
MET WITH:	Azeb Geberegziabie - Caregiver		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Resident's care needs are not being met.
Resident's diapering needs are not being met.
Resident is in bed for an extended period of time.
Facility is restricting the amount of time a visitor can visit.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Azeb Geberegziabie caregiver at the facility and explained the reason for the visit. Administrator Chante Smith arrived shortly thereafter.

During the initial visit conducted on 6/30/2022, LPA Kruz Long obtained a copy of the Staff/Resident roster and Resident #1's (R1) records (Preplacement Appraisal Information, Physician's Report, Resident Appraisal), and interviewed 2 staff members along with 6 residents at the facility. During today's visit, LPA Zaragoza obtained a copy of the current Staff roster, Resident roster along with the information of each resident's Responsible Party, and the admission agreement for the facility at the time the complaint was filed on 6/22/2022. LPA also interviewed Staff #1 - 3 (S1, S2, S3), Residents #2 - 7 (R2, R3, R4, R5, R6, R7), and attempted to interview all of the resident's responsible parties as well. LPA attempted to interview R1 however the resident has since passed away.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 3

Control Number 28-AS-20220622082234

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: J AND C HOUSE OF LOVE II	FACILITY NUMBER: 198603426
	VISIT DATE: 08/17/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Resident's care needs are not being met", it is alleged that the facility staff have been neglecting or ignoring the needs of the residents. During an interviews with the residents at the facility, none of them corroborated the allegation that their care needs are not being met by the facility staff. R2, R3, R5, R6, and R7 all explained that their needs have been met by the staff and always get assistance when they ask for it. They additionally stated that they have a good and positive relationship with the staff and that they can communicate their needs easily with them. All three staff members denied the allegation that resident care needs are being met, and stated that they make sure that the resident's showering, dressing, grooming, incontinence supply changing, and medication needs are being met every day.

In regards to the allegation "Resident diapering needs are not being met", it is alleged that the staff have been leaving residents in wet and soiled diapers for long periods of time without changing them. During interviews with the residents, none of them could corroborate the allegation that diapering needs are not being met. R2, R3, and R6 all explained that their incontinence supplies are being changed by staff when they are supposed to. The remaining residents who said they do not wear incontinence supplies stated that the residents who do require assistance with changing do get help when they need it. All staff members denied the allegation, and stated that they change the resident's incontinence supplies in the morning before breakfast, and check with the residents throughout the day and before bed to ensure that their changing needs are being met.

In regards to the allegation "Resident is in bed for an extended period of time", it is alleged that the staff at the facility leave the residents in bed for long periods of time without checking on them or asking them if they want to move from their beds. During interviews with the residents, none of them corroborated the allegation that they are left in bed for extended periods of time against their will. R3, R6, and R7 all stated that they get help from the staff when they ask to be taken out of bed. R2 explained that R2 is bed-bound and therefore cannot leave R2's bed, and R5 showed that they can get out of bed unassisted. All staff members state that they encourage the residents to get out of bed every day, however if residents tell them that they do not wish to leave bed, then it is within the resident's right to remain in bed. Staff stated that they never leave residents in bed willingly or ignore their request to get out of bed.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220622082234

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: J AND C HOUSE OF LOVE II	FACILITY NUMBER: 198603426
	VISIT DATE: 08/17/2023

NARRATIVE

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In regards to the allegation "Facility is Restricting the amount of time a visitor can visit", it is alleged that at the time the complaint was filed in June of 2022, the facility were forcing visitors to call the facility ahead of time and would take 10-15 minutes before finally allowing them to enter the facility to see the residents, and that families were not allowed to stay for a long period of time. Five (5) out of six (6) residents could not corroborate the allegation of this complaint. R2, R3, R6, and R7 stated they have no issues with their family or friends coming to visit them and that they can stay as long as they want. R3, R5, and R7 stated that visitors are not allowed to stay after 6 PM but that has been in the admission agreement and house rules ever since they have been living at the facility. LPA called the Responsible Parties of every resident of the facility to ask if there have been any issues or restrictions on visitation. LPA spoke with two (2) Responsible Parties for the residents, and neither of them reported any issues regarding visitation rights, however one did express that they needed to call the facility ahead of time in the past before being allowed to visit. In interviews with the staff, the Administrator stated that around the time this complaint was filed, they did limit visitation hours between the times of 10:00 AM - 6:00 PM, and asked them to call ahead of time before they arrive because they had a limit on how many people could be in the house at once. Administrator stated that in the present, visitors are allowed at any time and can stay as long as they want, but the facility still does require masking for all visitors.

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.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

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