198603586-9-18-2023-28-AS-RORN-CW4QHQ-20230928121130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 09/18/2023
Date Signed: 09/18/2023 03:51:15 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
09/13/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230913085414

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: 37	DATE:	09/18/2023
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Claudia Sanchez, Assistant Administrator		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Staff are mismanaging resident's medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alberto Lopez made an unannounced visit to conduct a complaint investigation visit. LPA met with Assistant Administrator Claudia Sanchez and explained the purpose of the visit.

Investigation consisted of LPA taking tour the facility and reviewing the MAR, Physicians Report and medications for 4 residents. LPA interviewed 4 staff (S#1-S#4) and 7 residents (R#1-R#7)

Allegation: Staff are mismanaging resident's medication. It is alleged that facility is mismanaging client’s medications and that medications are missing for R1.
The investigation revealed that medication is being administered according to doctor's orders. LPA conducted interviews with Assistant Administrator, Staff #1 (S1) and Staff #2 (S2). LPA conducted interviews via phone with Staff #3 (S3) and Staff #4 (S4) All 4 staff denied the allegation. Three staff responsible for administration of medications stated they are in constant communication to prevent medications errors.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

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-20230913085414

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: HENRIETTA'S LEVEN OAKS	FACILITY NUMBER: 198603586
	VISIT DATE: 09/18/2023

NARRATIVE

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(Continued)

LPA conducted interviews with Residents #1 (R1) - Resident #7 (R7) 6 of 7 residents could not collaborate the allegations. 6 of 7 residents stated they get their medications according to doctor's orders and are satisfied with facility administering their medications.

LPA reviewed 4 medications files and all medications are accounted for and administered according to doctor's orders.

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: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023

LIC9099 (FAS) - (06/04)

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