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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 03/11/2025
Date Signed: 03/11/2025 11:37:46 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
03/06/2025 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20250306144620
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: 48DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Madelene Sanchez - Med-TechTIME COMPLETED:
11:49 AM
ALLEGATION(S):
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Staff does not meet resident’s bathroom needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Madelene Sanchez Med tech and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/resident rosters. LPA interviewed 5 residents and 5 staff. LPA reviewed 3 resident files and requested copies of physician’s report, pre-appraisal assessment, appraisal, and staff in-service training.

The investigation revealed the following: Regarding allegation: Staff does not meet resident’s bathroom needs. It is alleged a resident who requires assistance with all activities of daily living (ADLs) was not assisted in using the restroom resulting in resident having dry feces stuck to the body in more than one occasion.
(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST 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)
Page: 1 of 2
Control Number 28-AS-20250306144620
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: 03/11/2025
NARRATIVE
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Interviews conducted with residents revealed staff are assisting residents with ADLs and changing them as needed. Interviews conducted with staff revealed caregivers assist residents with bathroom reminders and changing residents with incontinence at least every two hours or as needed. Per administrator, residents are change every two hours. Staff have been provided training prior to employment and have provided in-service training regarding hygiene practices. Administrator added that they will be implementing a protocol to ensure that there are records regarding care provided to resident #1 (R1). Per document review R1 does require assistance with all ADLs, including toileting. On 1/16/25 Staff In-Service Training was provided on Proper Hygiene Practices.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Madelene Sanchez and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST 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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