198603586-8-30-2023-28-AS-RORN-CVNQ96-20230914115750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 08/30/2023
Date Signed: 08/30/2023 04:31:02 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
08/22/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230822163205

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: 39	DATE:	08/30/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Interim Administrator- Claudia		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is not following proper eviction procedures.
Facility staff did not safeguard resident’s belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted a complaint investigation regarding the allegations listed above. LPA met with Claudia Sanchez, Interim Administrator and explained the reason for the visit. At 1:00pm Substitute Administrator Stephany Perez assisted with the visit.

During today's visit: LPA toured the facility along side with Claudia Sanchez. LPA observed med-tech room lost and found area and the laundry room lost and found area, R1's bedroom was observed. LPA obtained copies of the following documents: Staff & Resident Rosters, Resident #1 (R1) : Face sheet (ID and Emergency Info.), Physician’s report and Admission's Agreement. LPA obtained facility daily notes and rent invoices regarding R1. LPA conducted interviews with Assistant Administrator, Sub-Administrator, Staff #1 (S1) and Staff #2 (S2) . LPA conducted interview via telephone with Staff #3 (S3) . LPA interviewed Resident #1(R1) - Resident #5(R5). LPA Calderon attempt to interview former case manager of R1 via telephone, LPA interviewed R1's program manager and interviewed facility Accounting personnel.
(CONTINUATION ON LIC9099-C... )

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

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-20230822163205

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: 08/30/2023

NARRATIVE

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Regarding Allegation: Facility is not following proper eviction procedures. The investigation revealed Substitute Administrator Stephany Perez, Interim-Administrator and Facility Accounting denied the above allegation, all stated residents are provided a proper eviction notice. and all eviction notice can occur due to non-payment of rent. All stated R1 is past due on rent and residents are provided a time frame to pay rent to avoid eviction. Interviews with S1 -S3 all could not contribute the above allegation stating they do not have knowledge about in proper evictions or evictions. S2 stated knowing about an eviction letter provided to R1 due to non-payment of rent. Interviews with residents were conducted. Interviews with residents revealed R1 stating they pay what they can pay for rent as they have other priorities. Interviewed with R2-R5 all revealed residents not aware of in proper evictions occurring. Interview with R1 program manager stated overseeing 18 residents at the above facility and denied the above allegation stating facility is not providing in proper evictions to the residents in care. LPA reviewed invoices of rent for R1 showing R1 has a balance that has not been paid, owing the facility rent payments. LPA reviewed and approved a proper eviction notice provided regarding R1, reason for eviction noted is: non-payments. Facility does not have other evictions in place for residents in care. There were no evidence obtained during the investigation to corroborate with the allegation.

Regarding Allegation: Facility staff did not safeguard resident’s belongings. LPA interviews with staff Substitute Administrator Stephany Perez, Interim-Administrator and Facility Accounting revealed all denying the above allegation and all stated facility is safeguarding residents belongings by providing each resident with their own furniture items/ space and residents are advised before entering facility that residents are responsible of personal items and the facility has dementia residents which can occur to items being misplaced. Interview with facility accounting revealed facility not having an issues with residents belongings not being safeguarded. Interviews with staff, S1-S3 stated residents have their own space for their items and facility help relocate items if missing. S1 and S3 stated facility has Dementia residents and at times things can get relocated or misplaced and facility investigate and looks for items. Interviews with residents revealed R2-R5 all denied the above allegation stating they have their belongings safeguarded in their room and not sure if other residents items are being safeguarded or not but they do not have issues personally. R3 former roommate of R1 stated witnessing staff entering room to clean/ preform their duties and staff were not stealing from R1. Interview with Program Manager of R1 revealed R1 stating a convoluted story regarding facility not safeguarding residents belongings and is not aware of issues regarding facility not safeguarding residents belongings. There were no evidence obtained during the investigation to corroborate with the allegation.

Based on interviews and record reviews there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided to Claudia Sanchez, Interim-Administrator.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023

LIC9099 (FAS) - (06/04)

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