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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 01/28/2025
Date Signed: 01/28/2025 04:34:36 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
01/10/2025 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250110152829
FACILITY NAME:HENRIETTA'S LEVEN OAKSFACILITY NUMBER:
198603586
ADMINISTRATOR:STEPHANY PEREZFACILITY TYPE:
740
ADDRESS:120 S. MYRTLE AVENUETELEPHONE:
(213) 478-0800
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:80CENSUS: 42DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maggie Sanchez, Assistant AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff are not meeting resident's hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the above allegation. LPA met with Assistant Administrator, Maggie Sanchez, to explain the purpose for the visit.

On 1/16/25, LPA Chan made the initial visit and obtained copies of the staff roster, resident roster, and documents pertaining to Resident #1. LPA also conducted interviews with Staff #1 - #5, and Residents #1 - #6. Additional 2 staff were interviewed on another date.

For allegation, Staff are not meeting resident’s hygiene needs. It is alleged that Resident #1 (R1) has feces stuck to the bottom and is extremely difficult to remove. Seven staff interviewed indicated that they meet the needs of all residents daily. R1 and other residents are cleaned thoroughly. They stated their protocol is to check residents every 2 hours and change their diapers if needed. R1 is changed frequently due to incontinence, and they have not noticed any feces stuck on R1’s bottom during changes or showers.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 2
Control Number 28-AS-20250110152829
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: 01/28/2025
NARRATIVE
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Per staff, R1 also has bowel movements a few times a day and use baby wipes to clean the bottom. Staff do not know about the stool being stuck to the resident’s bottom as it had never been seen. R1 also had not reported or shown any discomfort during changes. Per the med tech, there were no reports of R1 having stuck feces on any doctor’s visits. All the residents interviewed feel that the staff meet their needs and change them when needed. They also feel that they do a good job cleaning them.

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.



An exit interview was held. A copy of this report along with the appeal rights was provided to the Assistant Administrator.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2