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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004010
Report Date: 12/08/2022
Date Signed: 12/08/2022 12:31:54 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
02/07/2022 and conducted by Evaluator Kathrina Chin
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220207153621
FACILITY NAME:LE-NA'RESIDENTAL CARE, INC.FACILITY NUMBER:
306004010
ADMINISTRATOR:LEONA SMITHFACILITY TYPE:
735
ADDRESS:5521 LOCKHAVEN DRIVETELEPHONE:
(714) 670-8397
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY:6CENSUS: 6DATE:
12/08/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jamie Lee, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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1)The facility does not have sufficient staff based on the resident's needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kathrina Chin made an unannounced visit to the facility to conclude a complaint investigation. LPA met and discussed the purpose of the visit with Jamie Lee, Administrator.

LPA Chin reviewed all six client's Individual Program Plans(IPP) which showed that these six residents require a staffing ratio of 1:2. This means that the facility needs to have three staff members for six clients.
LPA obtained facility staff schedules from October 2021 through January 2022. It showed that there were many days in which there were only two staff members to care for six residents in this Adult Residential Facility(ARF). Jamie Lee, Administrator stated that the facility normally has three staff members for the morning shift and night shift and one awake staff for 9 PM to 6 AM. LPA also interviewed four staff members who reported that there are some shifts where there are only two staff members to care for six residents.

(Continued on LIC 9099 C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
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-20220207153621
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: LE-NA'RESIDENTAL CARE, INC.
FACILITY NUMBER: 306004010
VISIT DATE: 12/08/2022
NARRATIVE
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LPA Chin reviewed staffing schedules and it showed that there were only two staff members on these dates for September 16, 23, 25, 30 of 2021 and November 4, 5, 11, 12, 16, 17, 18, 19, 22, 22, 23, 24, 25, 26, 27, 29, 30 of 2021 and December 3, 5, 7, 10, 11, 12, 14, 21, 22, 23, 28, 29, 30 of 2021 and January 1, 4, 5, 6, 7, 17, 22, 24, 29, 31 of 2023. This means that there were 4 days in September 2021, 17 days in November 2021, 13 days in December 2021, and 10 days in January 2023 in which there were only two staff members caring for six residents when there should be three staff members needed.

Based on LPA's observations and conducted interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiency is a violation of Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted along with appeal rights were provided and a copy of this report was left.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20220207153621
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: LE-NA'RESIDENTAL CARE, INC.
FACILITY NUMBER: 306004010
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2022
Section Cited
CCR
80066
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(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs. This requirement was not met as evidenced by : Based on observation and documents, the licensee did not have sufficient staff to provide care and supervison to six residents in care for several days in months of November 2021, December
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Jamie Lee, Administrator stated that she will submit a plan of correction by December 12, 2022.
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 2021,January 2023. Staff schedules for September 2021, November 2021, December 2021 and January 2023 had many days in which the facility had two staff members when three staff members were needed to care for the six residents. This poses a potential risk to the residents 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: Sheila Santos
LICENSING EVALUATOR NAME: Kathrina Chin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3