198603586-3-28-2024-28-AS-RORN-D3XMBJ-20240402092802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 03/28/2024
Date Signed: 03/28/2024 03:14:14 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
12/07/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231207103650

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: 33	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Claudia Sanchez (Interim Administrator)		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Illegal eviction without proper notice
Staff retaliating against the RP for filing a complaint with CCLD

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent visit to deliver findings for the above allegations. LPA met with Claudia Sanchez (Interim Administrator) and discussed the purpose of today's visit.
During today's visit, LPA interviewed Department of Health Services Representative (Placement Agency) telephonically at 1:35 PM.
The initial visit was conducted on 12/12/2023 and included the following:
LPA obtained a copy of the staff roster and resident roster and Special Incident Reports (SIR's). LPA reviewed Resident #1 (R-1's) file and obtained relevant documentation. LPA also interviewed Claudia Sanchez from 9:30 to 9:55 AM.
Resident's R 1- R 6 were interviewed from 10:30 AM to 11:30 AM.
In regards to the allegation Illegal eviction without proper notice, based on interviews conducted and information gathered it was revealed by Department of Health Services Representative (Placement Agency) Program Manager that they prevent an eviction from happening. Stated that they will try to relocate if

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20231207103650

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: 03/28/2024

NARRATIVE

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they assess that the resident is not compatible and not a good fit.
Said they avoid eviction and ensure the resident is relocated to a safe environment.
Interview with Interim Administrator who stated that Resident R 1 has never faced eviction. Stated that there is an internal relocation that is done by Department of Health Services.
Also stated that any special incident reports are sent to Department of Health Services.
LPA reviewed e-mail exchange between Administrator and Department of Health Services Representative who communicated to family member of R 1 that she can relocate R1 or take home.
Review of R1's file shows that R1 does not have a POA or Conservator.
It should also be noted that R1 is still currently residing at this facility.
Interviews with 6 of 6 resident's who all stated they had not seen or heard of anyone being evicted and all stated staff all act professionally.
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 retaliating against the RP for filing a complaint with CCLD, based on interviews conducted and information gathered it was revealed by Department of Health Services Representative (Placement Agency) Program Manager that they have worked closely with the facility and find no reason to corroborate the allegation. Stated they never heard of anyone complain that the facility was threatening anyone who complained as a retaliation tactic.

Interview conducted with Interim Administrator who stated the last complaint in November was Unsubstantiated and R 1 was not being evicted as retaliation because it was an internal relocation by Department of Health Services.

Interview with 6 of 6 residents who all stated that staff do not engage in wrong doing and that they are professional and work really well with the residents. All 6 have not heard of any retaliation if someone complained to CCLD. R 1 stated that employees had done no wrong doing to her or retaliated against her. It should be noted that R 1 still currently resides at the facility.

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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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