198603506-5-22-2023-28-AS-RORN-CSZTCA-20230621143624

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603506
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:53:03 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
02/24/2023 and conducted by Evaluator Bennette Pena

PUBLIC

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:	DATE:	05/22/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Divette Bias, Direct Support Professional & Program Supervisor		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Licensee does not ensure that kitchen sink delivers hot water.

INVESTIGATION FINDINGS:

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********This report supersedes the original complaint investigation report created on 3/01/2023. The reason is to change the investigation findings as the original report dated 3/01/2023 had incorrect findings.**********

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to investigate the above allegation. LPA met with Josanne Lambert/Direct Support Professional and Divette Bias/Direct Support Professional (DSP) & Program Supervisor and explained the reason for the visit.

During the initial visit conducted on 3/01/2023, LPA Pena 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.

During today's visit, LPA Pena conducted a tour of the facility's common areas and obtained copies of staff and clients rosters. LPA issued a Case Management deficiency report for the hot water temperature in client's bathroom #1.
*****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: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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-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: 05/22/2023

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. On 3/01/2023, 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 several times, on 12/20/2022 and the plumber flushed the water in the water heater tank. On Feb 2023, the plumber serviced the facility again to check the hot water. S2 stated that it's been an ongoing issue but it still takes minutes before the hot water comes out. 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 statements and interviews conducted with clients and staff as well as reviewed files and documentation, 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.

An exit interview was conducted, and a copy of this report was provided to Divette Bias, Direct Support Professional (DSP) & Program Supervisor.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

LIC9099 (FAS) - (06/04)

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