198603505-4-12-2023-28-AS-BPEA-CQTPY2-20230412114312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603505
Report Date: 02/08/2023
Date Signed: 04/12/2023 11:43:12 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
02/07/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230207120931

FACILITY NAME:	REM CALIFORNIA, LLC - GLENWOOD		FACILITY NUMBER:	198603505
ADMINISTRATOR:	PARRA, DENISE		FACILITY TYPE:	735
ADDRESS:	2418 GLENWOOD PLACE		TELEPHONE:	(323) 249-8299
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	4	CENSUS: 4	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Lisa Renee Clark, DSP I		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not keep facility free from pests.
Facility toilet is in disrepair.

INVESTIGATION FINDINGS:

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***This report dated 02/08/2023 is being amended to make a correction on the sections cited on LIC9099-D. No other information is being changed. Investigation findings on this report remain the same. ****

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced complaint visit regarding the above allegations. LPA met with Lisa Renee Clark, DSP I and Guadalupe Cortes, DSP I and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of staff and client rosters, service reports/invoices from Plumbing company (Rooter Hero) and Exterminator (Total Ext. Inc.), interviewed Staff #1 (S1) telephonically and Staff #2 (S2) - Staff #5 (S5), Client #1 (C1) - Client #2 (C2) and attempted to interview Client #3 (C3) - Client #4 (C4) but unsuccessful due to their cognitive abilities. LPA conducted a virtual tour of the facility which included common areas, bedrooms, bathrooms and kitchen area.

(CONTINUED ON 9099C)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 28-AS-20230207120931

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: REM CALIFORNIA, LLC - GLENWOOD	FACILITY NUMBER: 198603505
	VISIT DATE: 02/08/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation:"Facility staff did not keep facility free from pests", it is alleged that cockroaches were observed crawling around the facility and is an ongoing issue for 2-3 months. Interviews conducted with staff members revealed that they all have seen the bugs, cockroaches in the facility and kill them when they see it. They saw the big cockroaches in the hallways, bedrooms and bathrooms and small cockroaches in the kitchen sink and drains. 5 out of 5 staff stated that staff and clients had to leave the facility and moved to another house around Oct. 2022 because of the major plumbing problems with the pipelines underground in the facility. This problem caused the infestation of the cockroaches. Exterminator has been called and the pest control service started in January 2023. The Administrator provided LPA with pest control invoices. 4 out of 5 staff stated that they still see cockroaches around but not as often as it used to be. Interviews with C1-2 revealed that they have seen cockroaches and bugs in the facility for months now. C1-2 indicated that they kill cockroaches with their shoes or fly swatter. C1-2 indicated that they still see cockroaches and bugs in the facility and consider it to be a safety and health issue.

In regards to the allegation: "Facility toilet is in disrepair", it is alleged that when residents flush the toilet, water comes back up. Interviews with 5 out of 5 staff stated that the toilet in one of the bathrooms had been broken on and off for some time now. S1-S5 stated that the toilet gets clogged due to one of the clients throwing personal items in the toilet. S1 called a plumber many times to fix it but due to C2 putting items in the toilet, it keeps getting clogged. During physical plant tour of the facility, LPA observed that the toilet is broken and clogged (photos available). S2-S5 confirmed that it is out of service and no one is using the toilet. Interviews with C1-2 revealed that they were instructed not to use the back toilet because it was broken. C1-2 use the other bathroom which is working, but they usually wait before they can use it as there is only one (1) working bathroom available.

Based on LPA’s observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6, is being cited on the attached LIC 9099D.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230207120931

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: REM CALIFORNIA, LLC - GLENWOOD	FACILITY NUMBER: 198603505
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/08/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2023 Section Cited CCR 80088(e)(3)	1 2 3 4 5 6 7	80088 Furniture, Fixtures, Equipment, and Supplies...(e) Faucets used by clients for personal care .....(3) All toilets..shall be maintained in safe and sanitary operating condition. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator will provide LPA the Plumbing invoices/service reports. The Administrator will also conduct an in-service training for the staff on how to prevent the toilet being clogged by the client.
	8 9 10 11 12 13 14	Based on observation, interviews, records review, the Administrator did not comply with the section cited above in which based on tour of physical plant, LPA observed that the toilet is broken and out of service. This poses a potential health, safety, and/or personal rights risk to the clients in care.	8 9 10 11 12 13 14	A copy of the training signed by the staff will be submitted to LPA by the POC due date.
Type B 02/17/2023 Section Cited CCR 80087(a)(1)	1 2 3 4 5 6 7	80087 Buildings and Grounds..(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients..(1)The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has provided LPA the exterminator invoices for Jan 2023. Administrator will train the staff for bug prevention measures and will send LPA a copy of the in- service staff training with the
	8 9 10 11 12 13 14	Based on observation, interviews, records review, the Administrator did not comply with the section cited above in which staff admitted seeing and killing big cockroaches and bugs in the facility. This poses a potential health, safety, and/or personal rights risk to the clients in care.	8 9 10 11 12 13 14	items/materials discussed by POC due date.

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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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