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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 300607404
Report Date: 05/22/2023
Date Signed: 05/22/2023 01:25:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230307163014
FACILITY NAME:LAURENCE RESIDENTIAL CAREFACILITY NUMBER:
300607404
ADMINISTRATOR:LAURENCE, VERNELLFACILITY TYPE:
735
ADDRESS:3722 S. ROSS ST.TELEPHONE:
(714) 662-7771
CITY:SANTA ANASTATE: CAZIP CODE:
92707
CAPACITY:6CENSUS: 5DATE:
05/22/2023
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Facility Administrator - Vernell LaurenceTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Client medication not being administered as prescribed.
Staff did not ensure clients were free from intimidation and verbal abuse.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received from 03/07/2023. LPA De Perio arrived at the facility, was greeted by facility administrator (AD) Vernell Laurence and staff on duty (S1) Patricia Ingram, and LPA De Perio explained reason for visit.

It was alleged that client medication not being administered as prescribed. LPA De Perio conducted a total of 9 interviews which consisted of staff and clients. 2 out of the interviews conducted, corroborated with the allegation. LPA De Perio reviewed the physician report for client 1 (C1) and observed that C1's most recent physician report dated for Jaruary 2023, indicated that C1 has been prescribed over-the-counter medications, however 1 interview admitted that the facility does not have any nonprescription medications readily available for clients.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
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 22-AS-20230307163014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LAURENCE RESIDENTIAL CARE
FACILITY NUMBER: 300607404
VISIT DATE: 05/22/2023
NARRATIVE
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It was alleged that the staff did not ensure clients were free from intimidation and verbal abuse. LPA De Perio conducted a total of 9 interviews which consisted of staff and clients, and 7 out of the 9 interviews conducted, corroborated with the allegation, of which 1 interview directly admitted to calling client 2 (C2) a "bully".

Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED.

For today's visit, citations were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Laurence and S1 Ingram. A copy of this report was provided and explained.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230307163014
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAURENCE RESIDENTIAL CARE
FACILITY NUMBER: 300607404
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/23/2023
Section Cited
CCR
80075(b)
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80075 Health Related Services

(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidence by:
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As a plan of correction, (POC), facility will provide proof of understanding of the regulation cited to the assigned LPA on or by 5/23/23, and will supply the facility with over-the-counter medications to adhere to all client physician reports.
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Based on LPAs interviews, record review and observations, facility failed to ensure that clients were assisted with nonprescription medications and failed to ensure that nonprescription medications were available at the facility. This poses an immediate health and safety risk for clients in care.
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Type B
05/29/2023
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) Each client shall have personal rights...
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not met as evidence by:
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As plan of correction (POC), facility will provide proof of understanding, and an in-service staff training with written proof regarding the regulation cited to the assigned LPA on or by 5/29/23. Facility will provide proof of understanding to assigned
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Based on LPAs interviews, record review, and observations, facility failed to ensure that clients were accorded dignity in his/her personal relationships with staff...
This poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3