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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603452
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:14:05 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/06/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20241106084417
FACILITY NAME:DHASA CARE IIFACILITY NUMBER:
198603452
ADMINISTRATOR:CARTER, S'HALANAFACILITY TYPE:
735
ADDRESS:757 MILLBURY AVETELEPHONE:
(626) 257-3574
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:4CENSUS: 4DATE:
11/12/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Anthony OkwudiTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff does not ensure adequate amount of food supply for clients.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint investigation visit regarding the above allegations. LPA Margaryan met with Anthony Okwudi and explained the reason for the visit. Administrator were notified about visit over the phone and arrived at 12:30 pm.

The investigation consisted of the following: LPA Margaryan toured the kitchen, obtained a copy of the staff roster, clients roster, reviewed C1 file and obtained copies of Face Sheet, Physician's Report, Doctor's note for complete physical exam on 11/6/24, Dentist visit / order for lite diet after oral surgery and Weight Record. LPA also obtained copies of Food Menu and Alternative meal request log in sheet. Interviews conducted with Administrator, Staff #1 (S1), Staff #2 (S2) , Service Coordinator (SC) from SGPRC, Client #1 (C1), Client #2 (C2). LPA was unable to interview Client #3 (C3) and Client #4 (C4) as they are non-verbal.

Continue 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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 2
Control Number 28-AS-20241106084417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: DHASA CARE II
FACILITY NUMBER: 198603452
VISIT DATE: 11/12/2024
NARRATIVE
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Regarding the allegation: Facility staff does not ensure adequate amount of food supply for clients. It was alleged that client not getting enough food and never feels full or satisfied. Client reports weight loss and exhaustion. During today’s visit LPA observed ample food supply and variety to prepare client meals. Items such as meats, ground beef, chicken, cheese, waffles, eggs, breads, oats, and cereals were observed. LPA also observed a variety of vegetables such as bell peppers, tomatoes, lettuce, onions, and other frozen veggies. Fruits observed included bananas, oranges, apples. Facility has 2 refrigerators which were fully stocked. Per Administrator, grocery shopping is usually done every week and as needed. Per interviews with staff members, facility keeps a list of items that are needed, and Administrator will go to the grocery store as needed. Administrator stated that clients provided three meals a day including healthy snacks of their choice and the portion are adequate. Interviewed S1 and S2 stated that served portions are enough and clients can request extra portions always. If client doesn’t like what's being served for a meal, they can request an alternative. Administrator, S1 and S2 stated that they didn't hear any complains from clients about food portions or clients not satisfied. Administrator provides LPA a copy of the menu and the alternative meal request log in sheet. The alternative meal sheet for breakfast, lunch or dinner, shows the clients can request turkey sandwich, pancakes, meatballs, salad, eggs, toast, bacon, fruit plate, yogurt. Interviewed C1 and C2 stated that the food is healthy and satisfying, portions are enough / adequate. C1 and C2 stated that they have different food options and if they do not want what is on the menu they can request a different meal option and they always can ask for extra food / portions. LPA observed the meal that was served to the clients at the time of visit. The portions of the meals were adequate and by client's request were provided extra portions. Administrator mentioned that C1 recently had a dental/ oral surgery. Due to having several teeth pulled, C1 was put on soft diet for about 2 weeks. C1 has lost weigh lately and was taken to C1's primary physician for a health and physical check and exam which was started by physician that C1 is in good health and C1's weight is okay and there is no signs for exhaustion. C1's weight record requested and reviewed by LPA. Interviewed C1 stated that he/she lose weight because workout a lot, trying to gain muscles. C1 also mentioned that he/she had an oral surgery recently and was on soft diet. C1 stated that he/she just started to eat regular food and enjoyed it / satisfied.

Based on the LPA's observation, interviews conducted with client and staff and document reviewed, 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. Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2