198603586-1-11-2024-28-AS-FFIS-D283J7-20240206171705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 01/11/2024
Date Signed: 01/11/2024 04:35:49 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
01/10/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240110104253

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: 38	DATE:	01/11/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Claudia Sanchez, interim administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility staff restrained resident.
Facility staff do not ensure residents are appropriately clothed.
Facility staff are not properly dispensing medication as prescribed.
Facility staff do not intervene when residents engage in physical altercations.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced 10-day complaint visit to this facility. Upon arriving at the facility, LPA met with interim administrator, Claudia Sanchez. LPA explained the purpose of today’s visit and discussed the allegations mentioned above.

The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, staff’s training records and residents’ facility files.

The investigation revealed the following:
In regards of facility staff restrained resident, it was alleged staff tied resident to a chair overnight. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents revealed they had never been tied to a chair ever and never seen any residents being tied to a chair. All four (4) staff interviewed denied the allegation.

(-continued in LIC 9099C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20240110104253

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: 01/11/2024

NARRATIVE

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Staff stated they were not allowed to tie residents to a chair and restrained resident was against Title 22 regulation. Per LPA’s observation, no residents were tied to their chairs during the physical plant. Thus, the facility did not restrain resident while in care.

In regards of facility staff do not ensure residents are appropriately clothed, it was alleged that residents were being left under dressed under cold temperatures. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents revealed staff clothed them appropriately and kept them warm. All four (4) staff interviewed denied the allegation. Staff stated caregivers would dress residents in layers accordingly and check residents if they were warm. Per LPA’s observation, residents were dressed in layers with sweaters, hats, socks, and gloves. Therefore, the residents were dressed appropriately to keep them warm.

In regards of facility staff are not properly dispensing medication as prescribed, it was alleged that medication was not administered to residents on time. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents stated staff administered their medication as prescribed and dispensed medication to them every morning, afternoon and bedtimes depending on their needs. All four (4) staff interviewed denied the allegation. Staff stated Med techs administered medication according to residents’ medication record and doctors’ orders. Per record reviews, residents’ medications were administered as prescribed, and medication matched with records with no discrepancy. Therefore, facility staff dispensed medication as prescribed.

In regards of facility staff do not intervene when residents engage in physical altercations, it was alleged that some residents would get into agreements and act aggressively towards others, but staff did not intervene. LPA interviewed residents, five (5) out of five (5) residents interviewed could not corroborate the allegation. Residents stated staff would intervene and separate the residents if residents got agitated or act aggressively toward others. All four (4) staff interviewed denied the allegation. Staff stated staff were trained to handle residents with aggressive behavior and residents with dementia. Staff would intervene, separate and re-direct residents to do other activities. Per record reviews, staff had in-service training on handling aggressive residents and residents with dementia. Per observation, the residents were peace and calm. Therefore, there was not preponderance evident to show staff does not intervene when residents were being aggressive towards others or engaged in physical altercation.

(-continued in LIC 9099C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240110104253

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: 01/11/2024

NARRATIVE

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Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with interim administrator, Claudia Sanchez. The findings were discussed. A copy this report was provided to Claudia at time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024

LIC9099 (FAS) - (06/04)

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