198603544-8-20-2024-28-AS-RORN-D8CQGJ-20240821120936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603544
Report Date: 08/20/2024
Date Signed: 08/20/2024 10:42:55 AM

Substantiated

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
07/23/2024 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240723135921

FACILITY NAME:	LOVE BEYOND WORDS RESIDENTIAL CARE		FACILITY NUMBER:	198603544
ADMINISTRATOR:	PIPER, TONIE		FACILITY TYPE:	735
ADDRESS:	14516 TACUBA DRIVE		TELEPHONE:	(310) 650-0545
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 5	DATE:	08/20/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Staff Briana Broach		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff inappropriately touched resident in care.
Staff was under the influence of alcohol while caring and supervising residents.

INVESTIGATION FINDINGS:

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**This report supersedes report dated 7/25/24. The purpose of the visit is to make corrections to the report for the deficiency cited on Section 80078(a). All other findings remain the same**

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with Staff Briana Broach and the purpose of the visit was discussed.

During the investigation LPA Villalobos obtained an investigation report from the Departments Investigation Bureau (IB) regarding the above allegations. The investigation was conducted by IB and was assigned to Investigator, Lorraine Patterson. IB's investigation consisted of the following: Interviews were conducted with Staff#1-4 (S1-S4) and Clients #1-#2 (C1-C2), files for C1-C2 were collected, camera footage was reviewed and collected, and text messages and hand written letter from staff were also reviewed and collected. IB investigation initially began from self-reported incident reports provided to the department on 1/21/24 and 1/26/24. The departments investigation revealed the following: Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

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-20240723135921

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: LOVE BEYOND WORDS RESIDENTIAL CARE	FACILITY NUMBER: 198603544
	VISIT DATE: 08/20/2024

NARRATIVE

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**This report supersedes report dated 7/25/24. The purpose of the visit is to make corrections to the report for the deficiency cited on Section 80078(a). All other findings remain the same**

In regards to the allegation "Staff inappropriately touched resident in care." it was alleged that a Staff #1 (S1) had inappropriately touched clients in care From IB's investigation, (4) of (4) Staff interviewed denied the allegation. (2) of (2) Clients interviewed corroborated the allegation. The department was first notified of the incident from a self report received on 1/21/24 where C1 reported to staff , after informing C2, that S1 had inappropriately touched C1 at the facility. The department then received another incident report on 1/26/24 where C2 reported that S1 had also inappropriately touched them in the facility between the dates of 1/10/24-1/14/24. S1's last day working at the facility was on 1/14/24. Interviews conducted by the investigator show that on 1/14/24 C1 was out in the facilities back patio along with S1. When C1 made their way back into the building, S1 placed their hand on C1's buttocks in a palm up cupped position. Interview with C1 stated that they expressed to S1 to not do that two times. S1 denied any knowledge of inappropriately touching clients as they stated to often be drunk. Investigator was able to review facility camera footage to corroborate that the incident occurred and observed S1 placing their hand on C1's buttocks. The camera footage reviewed corroborated the details provided from client interviews and shows there is sufficient evidence to substantiate the allegation. Based on interviews conducted, files reviewed, and observation the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

In regards to the allegation "Staff was under the influence of alcohol while caring and supervising residents." it was alleged that S1 worked while intoxicated on 1/14/24 and was neglectful in their care and supervision of clients. (2) of (4) Staff interviewed denied the allegation while the other (2) corroborated the allegation. (2) of (2) Clients interviewed could not corroborate the allegation. Interviews and files reviewed show that S1 and S2 were on shift in the afternoon of 1/14/24 starting at 2pm. Between 2pm-3:36pm S2 informed supervising staff via phone call that S1 was not okay and was slurring. S1 was not allowed to participate in medication call that afternoon. By 5:30pm S2 updated that they do not believe S1 is okay. Notes provided also detail that S1 had made a mess in the kitchen that they did not clean up while also neglected their duties as staff leaving S2 to pick up their work. Around 8pm S3 arrived to assist and shortly afterwards, S1 was dismissed for the day after falling off a chair...

Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240723135921

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: LOVE BEYOND WORDS RESIDENTIAL CARE	FACILITY NUMBER: 198603544
	VISIT DATE: 08/20/2024

NARRATIVE

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**This report supersedes report dated 7/25/24. The purpose of the visit is to make corrections to the report for the deficiency cited on Section 80078(a). All other findings remain the same**

Due to S1's behavior, S1 was sent by their supervisor to take an alcohol test with Concentra. S1 tested positive for alcohol and was fired effectively on 1/16/24. S1 admitted to the investigator that they were under the influence of alcohol when working on 1/14/24 and could not recall any information other than going to work drunk and being picked up by a family member that night. This shows the facility failed to provide proper care and supervision to clients in care as S1 was drunk for over 6 hours of their shift. Based on interviews conducted, files reviewed, and observation the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Citations are being cited today per California Code of Regulations, Tittle 22. Please see attached LIC 9099-D page. Exit interview held. A copy of this report and Appeal Rights were provided and discussed.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20240723135921

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: LOVE BEYOND WORDS RESIDENTIAL CARE	FACILITY NUMBER: 198603544
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/21/2024 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072. Personal Rights.( a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons.	1 2 3 4 5 6 7	Facility has fired S1 as of 1/16/24 and conducted sexual harassment and abusive conduct prevention training for all staff. Deficiency is cleared at the time of this visit.
	8 9 10 11 12 13 14	This was not met as evidenced by: S1 inappropriately touched C1 in the buttocks posing an immediate health and safety risk to clients in care and supervision.	8 9 10 11 12 13 14
Type A 08/21/2024 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	80078, Responsibility for Providing Care and Supervision.(a) The licensee shall provide care and supervision as necessary to meet the client's needs. This was not met as evidenced by :	1 2 3 4 5 6 7	Facility has scheduled and completed inservice training regarding care and supervision of clients since LPAs last visit. LPA was provided proof of completion by todays visit. Deficiency is cleared at the time of this visit
	8 9 10 11 12 13 14	S1 was intoxicated while at work on 1/14/24 and was unable to properly care for clients. This poses an immediate health and safety risk to clients in care.	8 9 10 11 12 13 14

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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024

LIC9099 (FAS) - (06/04)

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