198603586-3-11-2025-28-AS-FFIS-DF5QAD-20250326115944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 03/11/2025
Date Signed: 03/11/2025 12:26:33 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
03/04/2025 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250304103203

FACILITY NAME:	HENRIETTA'S LEVEN OAKS		FACILITY NUMBER:	198603586
ADMINISTRATOR:	STEPHANY PEREZ		FACILITY TYPE:	740
ADDRESS:	120 S. MYRTLE AVENUE		TELEPHONE:	(213) 478-0800
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	80	CENSUS: 48	DATE:	03/11/2025
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Staff Madeline Sanchez		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff does not assist resident to shower.
Staff does not maintain resident’s hygiene.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with staff Madeline Sanchez and the purpose of the visit was discussed. LPA contacted administrator Claudia Sanchez via phone call and informed of the visit.

LPA conducted the following on todays visit; LPA toured the physical plant, interviewed Residents #1-#5 (R1-R5), interviewed staff #1-#5 (S1-S5), collected copies of the staff and resident roster, reviewed and collected copies of documents from R'1s file related to the allegations. The investigation revealed the following:

In regards to the allegation "Staff does not assist resident to shower" it is alleged that staff are not assisting R1 with showers as needed. (5) of (5) Staff interviewed denied the allegation. (4) of (5) Residents interviewed could not corroborate the allegation...

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

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-20250304103203

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: 03/11/2025

NARRATIVE

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Staff interviewed stated that R1 is approached 2-3 times weekly for shower assistance but refuses assistance often. Staff stated R1 has shown to have a favorite staff and would request specific assistance only from them. Interviews showed that due to R1's continued shower refusal, the staff had begun logging the assistance refusal. LPA reviewed the log started on 3/1/25 and shows multiple shower refusals by R1 since then. File review of R1's appraisal shows that R1 only requires assistance to get into a shower but is able to shower themselves. R1 confirmed this via interview. LPA was unable to find evidence that staff refused or neglected to shower R1. Based on interviews, observations, and file review; 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.

In regards to the allegation "Staff does not maintain resident’s hygiene." it is alleged that staff do not assist R1 with changing and using the restroom. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. Staff interviewed stated to provide R1 with clean linen and clothing weekly. Staff stated they will assist R1 with changing when R1 allows staff to assist. Interview with R1 stated they maintain their hygiene themselves and does not need staff assistance to change or use the restroom. LPA observed R1 to be in clean clothing and no odors in their room were observed. Based on interviews, observations, and file review; 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.

Exit Interview conducted and a copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025

LIC9099 (FAS) - (06/04)

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