198603586-8-15-2024-28-AS-TVAO-D8AT8B-20240819143002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:24:04 AM

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
10/18/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231018094803

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:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Madelene "Sasha" Sanchez and Claudia Sanchez		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not provide adequate food service to resident.
Staff ignored resident's request for assistance.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Madelene "Sasha" Sanchez and discussed the purpose of today's visit. Claudia Sanchez arrived at approximately 9:50 A.M..

On 10/26/23, LPA Irra conducted the initial visit. During this visit, LPA obtained a copy of the staff roster(including staff contact information),resident roster, list of residents with special diets and menus. LPA reviewed Resident #1 (R-1's) file and obtained relevant documentation. LPA also interviewed Claudia Sanchez.

During the course of this investigation, LPA also interviewed Staff #1 (S-1) through Staff # 4 (S-4) and Resident #1 (R-1) through Resident #5 (R-5). LPA conducted a tour of the kitchen.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20231018094803

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: 08/15/2024

NARRATIVE

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Allegation: Staff did not provide adequate food service to resident. It has been alleged that this facility provides food that R-1 cannot eat (not provided with vegetarian options) and that the food portions served are not enough. Staff interviews revealed that staff provide adequate food service (including vegetarian options and food portions) to residents. Interviewed staff indicated that the kitchen has food items that accommodate residents with vegetarian requests. LPA conducted a tour of the kitchen. LPA observed the kitchen to be stocked with vegetarian options such as vegetarian egg rolls, vegetarian lentils, Indian food, cauliflower rice, Pad Thai vegetarian noodles and fresh vegetables (carrots, cabbage, celery, asparagus, broccoli). Resident interviews revealed that the facility provides adequate food service. Interviewed residents indicated that they are provided with adequate food servings and are given the option to substitute food items (upon request). Interviewed residents did not have any concerns pertaining to this matter. Interviews do not corroborate this allegation.

Allegation: Staff ignored resident's request for assistance It has been alleged that when R-1 asks for coffee, R-1 has to keep asking staff and is being ignored. Staff interviews revealed that staff do not ignore resident requests (including R-1). Interviewed staff indicated they provide residents with assistance in a timely manner. Resident interviews revealed that staff do not ignore residents’ requests. Interviewed residents indicated staff provide residents with assistance in a timely manner. Interviewed residents did not have any concerns pertaining to this matter. Interviews do not corroborate this allegation.

Although the allegations may have happened or is 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, appeal rights and a copy of this report was provided to Claudia Sanchez.

NOTE: LPA was experiencing technical difficulties during this visit.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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