198603593-11-16-2023-28-AS-LHIS-CXSMC4-20231121082851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603593
Report Date: 11/16/2023
Date Signed: 11/16/2023 11:07:38 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
10/30/2023 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231030085320

FACILITY NAME:	VALLEY STAR RANCHO LOS AMIGOS CRT		FACILITY NUMBER:	198603593
ADMINISTRATOR:	HONORE-HARRELL, ALISHA		FACILITY TYPE:	772
ADDRESS:	7735 LEEDS ST		TELEPHONE:	(562) 719-2865
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	16	CENSUS: 16	DATE:	11/16/2023
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Alisha Honore-Harrell		TIME COMPLETED:	11:24 AM

ALLEGATION(S):

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Staff are not ensuring that resident’s medical needs are being met while in care.
Staff are not ensuring that resident’s medication needs are being met while in care.
Staff are not ensuring that resident receives an adequate amount of food while in care.
Staff are not ensuring that resident’s mail is being processed.

INVESTIGATION FINDINGS:

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Licensed Program Analyst (LPA) Alberto Lopez made subsequent unannounced visit to investigate the above allegations. LPA met with Program Director Cindy Hodge. Administrator Alisha Horne arrived a short time later and assisted with the visit. LPA discussed the purpose of the visit.

The investigation consisted of LPA reviewing and obtaining staff and resident roster, food menu for week 2, C1 face sheet, Physicians report, medication list, Physicians notes and other pertinent information for C1.
The investigation consisted of interviews with seven staff S#1-S#7 (S1-S7) and Six clients C#2 – C#7 (C2-C7) C#1 was not available to interview at the time of visit.

LPA attempted to contact C#1 on 5 separate occasions and was unsuccessful. DMH was contacted and was unable to find any contact information or know of C#1 whereabouts.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

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-20231030085320

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: VALLEY STAR RANCHO LOS AMIGOS CRT	FACILITY NUMBER: 198603593
	VISIT DATE: 11/16/2023

NARRATIVE

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The investigation revealed:

Allegation: Staff are not ensuring that resident’s medical needs are being met while in care. It is alleged that client has not been getting assistance from facility in obtaining eye glasses, a wheelchair, walker, neck brace.

LPA interviewed seven staff S1-S7 and all seven denied the allegations. LPA interviewed six clients C2-C6 and all six could not collaborate with the allegations. LPA was unable to interview C1 after 5 attempts. S2 stated that C1 never asked for wheelchair, neck brace or walker. S2 stated S2 scheduled optometrist appointment but that C1 refused to go because C1 was having too much pain at the time. S3 stated S3 did not have a prescription for any durable medical equipment and that C1 was scheduled for a variety of appointments but stated to S3 that C1 didn’t want to go. C3 stated that C3 was able to get eyeglasses right away with assistant from staff. C3 also stated that C3 is taken to C3 medical appointments. C4, C5 and C7 stated all C4, C5 and C7 medical needs are being met at the facility. C6 stated facility staff helped C6 with medical needs and eyeglasses exam. There is insufficient evidence to substantiate this allegation.

Allegation: Staff are not ensuring that resident’s medication needs are being met while in care. It is alleged that narcotic medications are not available at the facility. LPA interviewed seven staff S1-S7 and all staff denied the allegations. Administrator, S1 stated that anything the doctor orders is provided at the facility. S3 stated that C1 was agitated and wanted strong pain killers. Nurse, S5 stated that anything that clients are prescribed when they arrive is provided to them. S5 stated that they increased the pain dosages for C1, but C1 wanted narcotics. S5 stated that to get narcotics prescribed C1 would have to be taken to emergency room and be prescribed the narcotic pain killers there. When C1 did go to emergency room, C1 was prescribed naproxen and antibiotics, but no narcotics, according to S7. In summary, facility staff stated that clients are provided with what their doctor prescribes. All clients interviewed stated that they are provided with their medications and are administered according to the doctor’s orders. There is insufficient evidence to substantiate this allegation.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20231030085320

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: VALLEY STAR RANCHO LOS AMIGOS CRT	FACILITY NUMBER: 198603593
	VISIT DATE: 11/16/2023

NARRATIVE

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Allegation: Staff are not ensuring that residents receive an adequate amount of food while in care. It is alleged that C1 asked for more food and was told no by staff. LPA interviewed seven staff and 7 of 7 staff denied the allegations. Staff interviewed stated that clients are provided with 3 meals breakfast, lunch, and dinner and three snacks in between meals. Staff also stated that clients are permitted to buy additional snacks and store them at the facility. S1 stated that clients are provided additional food or snacks if they ask. S3 stated clients are never denied food. Six clients C2-C6 were interviewed and 4 of 6 denied the allegations. One client stated that facility has fixed time for meals and snacks and one client stated that they were told they had to wait till morning for food. C2 stated that enough food is provided and that C2 has own supply of snacks. C5 stated the food amount is satisfactory. C7 stated they are offered an apple or granola bar if they ask for more snacks. There is insufficient evidence to substantiate this allegation.

Allegation: Staff are not ensuring that resident’s mail is being processed. It is alleged that one client was unable to get assistance mailing out correspondence or to print out emails at the facility. LPA interviewed 7 staff S1-S7 and 7 of 7 staff denied the allegations. S2 who is responsible for assisting clients stated S2 assisted C1 in everything C1 asked for. S2 stated that C1 would tell S2 that C1 was in pain and not follow through on C1 appointments for assistance at times. LPA interviewed six clients C2-C7 and all seven did not collaborate with the allegations. All clients interviewed stated that receive assistance with mailing letters and correspondence. There is insufficient evidence to substantiate this allegation.

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 with Administrator Alisha Horne and a copy of this report provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023

LIC9099 (FAS) - (06/04)

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