198603586-4-10-2025-28-AS-RORN-DG2T5V-20250424142609

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 04/10/2025
Date Signed: 04/10/2025 12:45:59 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
03/21/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250321140301

FACILITY NAME:	HENRIETTA'S LEVEN OAKS		FACILITY NUMBER:	198603586
ADMINISTRATOR:	STEPHANY PEREZ		FACILITY TYPE:	740
ADDRESS:	120 S. MYRTLE AVENUE		TELEPHONE:	(213) 478-0800
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	80	CENSUS: 47	DATE:	04/10/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Claudia Sanchez - Interim Administrator		TIME COMPLETED:	12:55 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner.
Facility staff did not ensure wheelchair was accessible to resident.
Facility staff covered resident's mouth with their hand.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit for the allegations listed above. LPA met with Claudia Sanchez, Interim Administrator and explained the purpose of the visit.

The investigation consisted of the following: On 03/27/2025, LPA toured the facility and obtained copies of the staff/resident roster, facility records and Resident #1 (R1) pertinent files that are relevant to the investigation. LPA also interviewed Staff #1-Staff #2 (S1-S2) and Resident #3 (R3) - Resident #6 (R6). Interview with Resident #2 (R2) was unsuccessful due to cognitive abilities. Prior to today's visit, LPA telephonically interviewed Staff #3 (S3) - Staff #4 (S4) and attempted to interview Staff #7 (S7) - Staff #8 (S8) but no response received.

During today’s visit, LPA obtained staff & resident rosters and copy of Monrovia PD information (investigated on 03/21/2025). LPA checked Resident #1’s bedroom and interviewed Resident #1 (R1), Resident #7 (R7) and Staff #5 (S5) - Staff #6 (S6). ****REPORT CONTINUED ON LIC 9099-C***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

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-20250321140301

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: 04/10/2025

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: “Facility staff handled resident in a rough manner.” It is alleged that on Wednesday 3/19/25 between 4:30pm and 5pm, a staff "threw R1 on the bed" during a change. It is also alleged that this was not the first time a staff handled R1 in a rough manner. No other details provided including staff names or descriptions. All staff interviewed denied the allegation. LPA interviewed (3) staff members who were scheduled to work during the specified time frame and denied ever treating any resident, including R1, in a rough manner. Interviewed staff stated that throwing a resident onto a bed during care would be considered abuse and emphasized that all residents are treated with dignity and respect. Interviewed staff also stated they receive regular training on residents' rights and abuse prevention, and they have not heard any complaints about rough treatment. S1 indicated that on 03/21/2025, Monrovia PD came to investigate and determined that no further action was necessary. (5) out of (6) residents interviewed stated they are treated well and have no issues or concerns. Interviewed residents stated they have never been touched roughly. LPA’s observations of staff-resident interactions showed no concerns, and no visible bruises were seen on any residents interviewed, including R1. Therefore, there was not enough evidence to support the allegation.

In regards to the allegation: “Facility staff did not ensure wheelchair was accessible to resident.” It is alleged that a staff placed R1’s wheelchair "far away from his bed" which caused R1 to fall when he attempted to get out of bed and into his wheelchair. No injuries reported or other details provided including staff names or descriptions. All staff interviewed denied the allegation and stated they always position wheelchairs close to the residents’ beds. Interviewed staff stated they place wheelchairs on the side of their beds to allow safe transfers for residents and ensure they are easily accessible to prevent falls during transfers from bed to wheelchair. Staff also indicated that they receive training on safe transfer techniques and how to assist residents with transfers. (3) out of (6) residents interviewed are wheelchair bound and they denied the allegation. Some residents interviewed stated that their wheelchairs are kept close to their beds for easy access and within a comfortable reach. Additionally, some residents stated that staff always assist them in transferring from bed to wheelchair. Therefore, there was not enough evidence to support the allegation.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250321140301

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: 04/10/2025

NARRATIVE

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In regards to the allegation: “Facility staff covered resident's mouth with their hand.” It is alleged that a staff covered R1’s mouth with their hand so that R1 could not breathe. No specific details about the staff member were given, and no injuries were reported. Interviewed staff members denied the allegation, stating they have never covered R1’s or any other residents’ mouth with their hands. Interviewed staff stated that doing so is considered abuse or neglect. Some staff stated they would report such actions to the Administrator immediately if they witnessed them. Staff indicated that covering a resident’s mouth could be dangerous and could lead to choking. (5) out (6) residents interviewed denied the allegation and stated that staff have never placed their hands over their mouths and have not witnessed any staff doing this to other residents. Some residents stated that they feel safe and comfortable in the facility. Therefore, there was not enough evidence to support the allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are 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 conducted and a copy of this report was provided to Claudia Sanchez, Interim Administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2025

LIC9099 (FAS) - (06/04)

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