198603506-3-1-2023-28-AS-RORN-CSZTCB-20230621143625

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603506
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:43:26 PM

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
02/24/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230224160606

FACILITY NAME:	REM CALIFORNIA, LLC - PENNSYLVANIA		FACILITY NUMBER:	198603506
ADMINISTRATOR:	SALAU, ADEMOLA		FACILITY TYPE:	735
ADDRESS:	11343 PENNSYLVANIA AVE		TELEPHONE:	(562) 529-2524
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	4	CENSUS: 4	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Ademola Salau		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee does not ensure that kitchen sink delivers hot water.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the above allegation. The purpose of the visit was discussed with Administrator Ademola Salau.

The investigation consisted of the following: LPA obtained copies of the staff and clients rosters and plumbing invoices. A physical plant tour of facility clients' rooms and common areas was conducted, LPA checked the hot water temperature in the kitchen sink, interviewed Staff #1-Staff #3 (S1- S3), Client #3-Client #4 (C3-C4), attempted to interview Client #1-Client #2 (C1-C2) but unsuccessful due to their cognitive abilities.
*****CONTINUATION ON LIC9099-C*****

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

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 5

Control Number 28-AS-20230224160606

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 - PENNSYLVANIA	FACILITY NUMBER: 198603506
	VISIT DATE: 03/01/2023

NARRATIVE

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Allegation: "Licensee does not ensure that kitchen sink delivers hot water."
It is alleged that the kitchen sink water is always cold for months and will never get hot even if water was kept running for over 5 minutes. At 10:45am, LPA tested the water temperature in the kitchen sink and let the water run before testing the temperature. Only after over 6 minutes that the hot water temperature warmed up and read at 116. 6 degrees F. Staff interviewed stated that they are aware of it and has been an issue for a long time. S1 stated that a plumber was called on 12/20/2022 to check it. S1 stated that the plumber flushed the water in the water heater tank. S2 stated that it's been an ongoing issue but it still takes minutes before the hot water comes out. LPA checked the water temperature in bathroom #1 and stayed below 100 deg F even after 11 minutes and 34 seconds, which is not within Title 22 guidelines. Interviews with the clients indicated that they do not use the hot water in the kitchen sink and do not know if it delivers hot water or not.

Based on LPA’s observations and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, is being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to the Administrator, Ademola Salau along with the Appeals Rights.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC9099 (FAS) - (06/04)

Page: 2 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
02/24/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230224160606

FACILITY NAME:	REM CALIFORNIA, LLC - PENNSYLVANIA		FACILITY NUMBER:	198603506
ADMINISTRATOR:	SALAU, ADEMOLA		FACILITY TYPE:	735
ADDRESS:	11343 PENNSYLVANIA AVE		TELEPHONE:	(562) 529-2524
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	4	CENSUS: 4	DATE:	03/01/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Ademola Salau		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Licensee does not ensure that facility thermostat is kept in working condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint visit to investigate the above allegation. The purpose of the visit was discussed with Administrator Ademola Salau.

The investigation consisted of the following: LPA obtained copies of the staff and clients rosters. A physical plant tour of facility clients' rooms and common areas was conducted. LPA verified thermostat readings, and at 10:40am, the heating and facility temperature was at 74 deg F (LPA took a photo of the thermostat) which was comfortable at the time of the visit. LPA interviewed Staff #1-Staff #3 (S1- S3), Client #3-Client #4 (C3-C4), attempted to interview Client #1-Client #2 (C1-C2) but unsuccessful due to their cognitive abilities.
*****CONTINUATION ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20230224160606

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 - PENNSYLVANIA	FACILITY NUMBER: 198603506
	VISIT DATE: 03/01/2023

NARRATIVE

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Allegation: "Licensee does not ensure that facility thermostat is kept in working condition." It is alleged that thermostat has been broken for months and the warm air does not come on when it’s cold or raining. Based on the tour of the facility, the allegation is not supported. LPA observed the thermostat reading at 10:40am, 11:30am and 1:05pm and read between 73-75 deg F (photos available). The thermostat is locked and only accessible by staff members in the facility. Interviews with staff members revealed that they can access the thermostat and can adjust it to accommodate everyone as necessary. S2 stated that the thermostat is set at a certain temperature and turns on if temperature drops or off once the set temperature is reached. S1-S3 stated that they did not hear anyone, including other staff members complain about heating or cooling issues. Client interviews revealed the facility never gets too hot and or too cold. Two (2) clients interviewed indicated they are comfortable with the temperature.

Based on statements and interviews conducted with clients and staff as well as LPA's observations, there was not enough supportive evidence to corroborate the allegation.

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, a copy of this report was provided to the Facility Administrator, Ademola Salau.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20230224160606

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 - PENNSYLVANIA	FACILITY NUMBER: 198603506
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/01/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 03/08/2023 Section Cited CCR 80088(e)(1)	1 2 3 4 5 6 7	80088 Furniture, Fixtures, Equipment, and Supplies...(e) Faucets ..shall deliver hot water...(1) Hot water temperature controls shall be maintained...to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator shall maintain a hot water log for the kitchen sink and client's bathroom #1. The Administrator shall ensure the hot water temp is measured within Title 22 regulations and recorded on the log daily and submit a copy of the log to LPA for 1 week starting 3/02/2023.
	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 there was no hot water in the clients bathroom. LPA measured the water temp and read 94.7 deg F even after 11 minutes of water running.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: 03/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2023

LIC9099 (FAS) - (06/04)

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