198603586-5-30-2023-28-AS-MVAO-CTNUUU-20230712155406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603586
Report Date: 05/30/2023
Date Signed: 05/30/2023 05:15:01 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
05/08/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230508105637

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:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	01:57 PM
MET WITH:	Claudia Sanchez, Assistant Administrator/Med-Tech		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff is not effectively communicating with an authorized representative
Staff are not addressing the residents needs while in care
Residents are being inappropriately restrained while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint investigation regarding the allegations listed above. LPA met with Claudia Sanchez, Assistant Administrator/Med-Tech and explained the reason for the visit. The Administrator is unavailable and not present in the facility during the visit.

During the initial complaint investigation conducted on 5/16/2023, LPA Bennette Pena toured the facility and obtained copies of the following documents: Staff & Resident Rosters, In-service training for staff regarding Residents Rights, reviewed Resident #1 (R1) and Resident #2 (R2) files suchas: Face sheet (ID and Emergency Info.), Resident Pre Placement Appraisal, Physician’s report and Admission's Agreement. LPA conducted interviews with Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #6 (R6). Interview with Resident #1 (R1) was unsuccessful due to cognitive abilities, and Resident #2 (R2) has already moved out of the facility. LPA also obtained contact information for additional staff.

During today's visit, LPA Pena obtained Staff & Resident Rosters, toured the common areas and interviewed Staff #5 (S5) and Resident #7 (R7) - Resident #8 (R8).
****CONTINUED ON LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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 3

Control Number 28-AS-20230508105637

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: 05/30/2023

NARRATIVE

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The investigation revealed the following:

Allegation: Staff is not effectively communicating with an authorized representative. It is alleged that a resident’s relative requested multiple meetings with S1 in regards to issues and S1 was not answering or being responsive. Interviews conducted with staff members indicated that S1 is busy but she has an open door policy and no scheduling needed if someone wants to speak to her. S1 stated that she provides her cell phone number to the residents and their family members/representatives. S1 indicated that she did not remember anyone asking for a meeting. S3-S5 stated that S1 responds to meeting requests and responds to residents requests or issue in a timely manner. Staff members indicated that depending on the issue(s), it takes 24 hours for S1 to respond, sometimes it takes 2-3 days, but she responds and communicates the progress to the residents and family members. Residents interviewed stated that they don't have any concerns about communicating with S1. Some residents stated that they get response immediately and S1 gets on it right away. Some residents indicated that they usually have to wait for days if they need to speak with her, so they just go to her office. Based on statements and interviews conducted with residents and staff, there was not enough supportive evidence to corroborate the allegation.

Allegation: Staff are not addressing the residents needs while in care. It is alleged that a resident often complains but she’s not being heard by management. And the resident’s roommate also complains a lot of the issues she brings up are not taken care off and it makes her feel like she’s not being heard. Interviews conducted with staff members indicated that they have enough care staff on the floor per shift to attend to the residents needs. S1 stated that she addresses all requests and issues that residents and their family members/representatives bring up. Some staff members interviewed stated that sometimes the response time is delayed, depending on the severity of the issues but staff deal with it, and not ignore the issues/concerns. Some staff members indicated that they feel overworked at times because they have to cover for someone who was off, but it does not happen all the time. Interviewed residents indicated that the staff's assistance was slow sometimes, but other days, the staff usually come around quick when they need help. Residents stated that they do not have concerns and they feel that their needs are being addressed by staff. Based on statements and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegation.

*****CONTINUED ON LIC9099-C*****

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230508105637

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: 05/30/2023

NARRATIVE

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Allegation: Residents are being inappropriately restrained while in care. It is alleged that at night they had residents tied up to the wheelchair. Interviews conducted with staff members indicated that they had not seen or heard any resident being tied up in the wheelchair. Staff members stated that they are not allowed to do that and are aware that they cannot restrain the residents in any way. Staff members also stated that they receive training regarding residents personal rights and how to deal with residents with Dementia. S1 denied the allegation and stated that she was not aware of any resident being tied up in a wheelchair, no one reported or brought this to her attention. (6) out of (8) residents interviewed stated that they did not see or heard any residents tied up in a wheelchair. Interviews conducted with the residents roommates stated that they did not witness their roommates tied up in the wheelchair at any time of the day. LPA did not observe any residents being restrained or tied in the wheelchair during the facility tour. There were no witnesses, camera footage, or evidence obtained during the investigation to corroborate with 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 and a copy of this report was provided to Claudia Sanchez, Assistant Administrator.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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