198603634-7-18-2024-28-AS-RORN-D8KTLN-20240828144949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603634
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:25:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/24/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230824164011

FACILITY NAME:	ANEW DAWN ADULT LIVING		FACILITY NUMBER:	198603634
ADMINISTRATOR:	DUFRENNE, PATRIA MARAVILLA		FACILITY TYPE:	735
ADDRESS:	4340 LOCKWOOD AVE		TELEPHONE:	(323) 426-9123
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90029
CAPACITY:	94	CENSUS: 74	DATE:	07/18/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Assistant Administrator Glacie San Juan		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Questionable Death.
Staff did not administer medication(s) to resident in a timely manner.
Staff did not provide assistance to resident in a timely manner.
Resident in care sustained an overdose due to lack of staff supervision.
Staff do not accord privacy to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint visit to investigate the above allegations. LPA met with Assistant Administrator Glacie San Juan and discussed the purpose of today's visit.
The initial visit was conducted on 08/28/2023 and the following was done:
The purpose of the visit was to conduct a 24 hour Health and Safety Check.
LPA conducted a tour of the building and grounds which included Activity Room, Medication Room, Dining Room, Kitchen, Laundry, and outdoor courtyard and smoking area.
There are 2 Floors with 18 Client rooms on the 1st floor and 29 Client rooms on the 2nd floor.
LPA did not observe any signs of neglect, abuse or other immediate health and safety threats.
At today's visit Staff S1- S3 and Assistant Administrator were interviewed from 10:30 AM to 11:30 AM.
Client's C2- C9 were interviewed from 11:35 AM to 12:30 PM.
Representative from the Hospice Agency was interviewed from 12:35 PM to 1:00 PM.
Client C1's file was reviewed and Admission Agreement, Documentation from the Hospice Agency, and

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

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 4

Control Number 28-AS-20230824164011

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ANEW DAWN ADULT LIVING	FACILITY NUMBER: 198603634
	VISIT DATE: 07/18/2024

NARRATIVE

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Physician's Report were submitted.
In regards to the allegation Questionable Death, based on interviews conducted and information gathered it was revealed by the Hospice Agency Representative that they received a referral from Greater El Monte Hospital that Client C1 needs placement. Medical records were sent to them.
Stated that the Admission date on Hospice was 07/07/2023 and he was on it till the day of his passing 07/12/2023.
Also stated that the cause of death was sepsis and end stage crones disease which Client C1 had prior to admission.
Said that Hospice visits were conducted on 07/08/2023 with 1 Nurse, 07/09/2023 with 2 Nurses, and 07/12/2023 with 2 Nurses and there were no vital signs that evening. The medical doctor and family were informed.
Stated that the facility staff looked after Client C1 while Hospice was not there. Said if any change in condition, or change in medication the facility would report the changes and also there was an on call number. Said the facility did have constant communication with Hospice.
Facility staff kept the patient clean and assisted with everyday living. Stated that the facility staff did carry out their duties. Hospice Nurse never reported that Client C1 was not taken care of. There was never any complaints from the Hospice Nurse or the Social Worker.
Interviews with facility staff all stated that Client C1 was on Hospice and it was for 6 days. Stated they met all his needs when Hospice was not there. Stated they would help him right away and they check on all clients every hour.
LPA viewed a signed log for all clients that were visited for their hourly check.
Interviews with Client's C2-C9 who all stated that facility staff respond right away and if emergency will call 911 immediately.
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff did not administer medication(s) to resident in a timely manner, based on interviews conducted and information gathered 8 out of 8 clients interviewed all stated that they have never missed a dose of medication administered by facility staff. All 8 stated that the medication is always ready and administered in a timely manner.
Interviews with staff who stated that pain medication will be given right away to a client on Hospice.
Stated they do not blow off the clients request for medication and did respond to Client C1 in a timely manner.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20230824164011

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ANEW DAWN ADULT LIVING	FACILITY NUMBER: 198603634
	VISIT DATE: 07/18/2024

NARRATIVE

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Interview with Hospice Representative who stated that all medications were administered properly by facility staff and also by Hospice when they were at facility.
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove
the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff did not provide assistance to resident in a timely manner, based on interviews conducted and information gathered Hospice Agency stated that the facility staff looked after Client C1 while Hospice was not there. Said if any change in condition, or change in medication the facility would report the changes and also there was an on call number. Said the facility did have constant communication with Hospice.
Facility staff kept the patient clean and assisted with everyday living. Stated that the facility staff did carry out their duties in a timely manner and the Hospice Nurse never reported that Client C1 was not taken care of. There was never any complaints from the Hospice Nurse or the Social Worker.
In interviews with Client's C2-C9 all 8 clients stated that facility staff always assist the residents right away when the pull cord is used and for any emergency situation will call 911 immediately.
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove
the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Resident in care sustained an overdose due to lack of staff supervision, based on interviews conducted and information gathered all 8 clients stated that there is a strict policy of no drug usage and drugs will be confiscated and an eviction notice given.
8 of 8 clients had not observed or heard on anyone having an overdose.
In interview with staff who stated it is not true of client having an overdose and they will monitor hourly to check on each client.
Also stated that substance abuse is not allowed and if it happens an eviction notice is given and they are in direct contact with the Case Manager.
Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove
the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff do not accord privacy to residents in care, based on interviews conducted and information gathered 8 out of 8 clients stated that staff will not discuss a clients personal issues in front of other clients and staff. Stated staff will bring a client into the office for a confidential conversation.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230824164011

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ANEW DAWN ADULT LIVING	FACILITY NUMBER: 198603634
	VISIT DATE: 07/18/2024

NARRATIVE

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Interviews conducted with staff who all stated that it is not true that staff speak in front of other clients and staff about a clients personal information.
All stated that confidential conversations take place in the office.

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

Exit interview conducted.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024

LIC9099 (FAS) - (06/04)

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