198603586-4-6-2023-28-AS-LHIS-CU5KWT-20230727081623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:11:38 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
03/13/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230313092735

FACILITY NAME:	HENRIETTA'S LEVEN OAKS		FACILITY NUMBER:	198603586
ADMINISTRATOR:	HARVEY, LUPE		FACILITY TYPE:	740
ADDRESS:	120 S. MYRTLE AVENUE		TELEPHONE:	(213) 478-0460
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	80	CENSUS: 26	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Claudia Sanchez, Administrative Assistant		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Staff do not treat resident with dignity or respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit in reference to the above allegations. LPA explained the purpose of the visit to Administrative Assistant/Med-Tech Claudia Sanchez. Administrator Lupe Harvey was not available during the visit.

The investigation consisted of the following: On 3/20/23 & today a tour of the interior and exterior physical plant was conducted. The physical plant tour focused on bathroom plumbing, hot water temperature, and kitchen food supply. Staff (S1- S6) and residents (R1 - R7) were interviewed. The following documents pertaining to R1 were reviewed and obtained: Identification and Emergency Information, Physician Report, Physician Order, resident roster, LIC 500 Personnel Report, and Food Menus [regular, special diets, and alternate menu]. NOTE: Documents not provided: Food Handling Certificates, Registered Dietician information (only website was provided), and plumbing report / invoice.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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-20230313092735

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: HENRIETTA'S LEVEN OAKS	FACILITY NUMBER: 198603586
	VISIT DATE: 04/06/2023

NARRATIVE

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Allegation: Staff do not treat resident with dignity or respect. It is alleged that a caregiver staff (S1) and Administrator (S2) treat residents in a rude and arrogant manner; and that the overall quality of service, responsiveness to resident concerns, and assistance to residents is not to facility standard. It is alleged that Administrator (S2) has been approached by a resident about physical plant and food concerns, but Administrator does not respond to resident (R1s) communication requests. Staff (S2) stated that R1 is constantly complaining about vegetarian diet. Both staff (S1) and staff (S2) denied treating resident (R1) in a disrespectful manner, and indicated that the resident is at times very rude to some staff and visiting health professionals due to it's mental health behaviors. Staff reported that R1 refuses a psychiatric evaluation, and has not given permission to it's doctors to release information to facility staff. Only one (1) corporate staff (S5) was given permission to obtain R1's general health information. One staff stated staff (S1) treats residents in a rude way. A total of seven (7) residents were interviewed. Three (3) out of seven (7) residents reported that at least 2 staff treat residents in a rude and inappropriate manner. However, there is insufficient evidence to corroborate the allegation.

Although the allegation(s) 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.

No Deficiencies cited under California Code of Regulations Title 22

Exit interview was conducted with Administrative Assistant Claudia Sanchez. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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