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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005891
Report Date: 04/09/2025
Date Signed: 04/09/2025 03:02:18 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
04/07/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250407093310
FACILITY NAME:NANTUCKET HOMEFACILITY NUMBER:
306005891
ADMINISTRATOR:RONNIE CHUAFACILITY TYPE:
737
ADDRESS:1051 NANTUCKET ST.TELEPHONE:
(562) 267-0102
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:3CENSUS: 2DATE:
04/09/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Pua TataTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff are not properly storing food
Facility staff are not properly trained
Facility staff did not ensure clients received medical services
Facility staff are not administering medications as prescribed
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegations. LPA met with Program Manager (PM) Pua Tata, discussed the purpose of the inspection, and explained the allegations.

The investigation into the allegations that facility staff are not properly storing food, facility staff are not properly trained, facility staff did not ensure clients received medical services, and facility staff are not administering medications as prescribed revealed the following: During the course of the investigation, LPA inspected the facility, interviewed PM and clients, and obtained and reviewed copies of the client roster, staff roster, staff training records, the facility’s staff schedule, Client #1’s (C1) Service Plan, C1’s Consultant Log, Client #2’s (C2) Service Plan, C2’s Consultation Log, C1’s Bowel Movement Log, and C1’s Medication Administration Records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
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 7
Control Number 22-AS-20250407093310
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: NANTUCKET HOME
FACILITY NUMBER: 306005891
VISIT DATE: 04/09/2025
NARRATIVE
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Regarding the allegation that facility staff are not properly storing food: it was alleged that a bag of snacks was left opened and not sealed in the kitchen cabinet and leftover food was wrapped in a paper towel in the kitchen refrigerator. LPA inspected the facility, conducted health and safety checks on the clients, observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required, and noted that expiration dates were marked and there were no expired foods. However, LPA also observed a bag of cookies left open in the kitchen pantry and a jar of food not properly sealed in the kitchen refrigerator. LPA interviewed PM who admitted the allegation, stated they had already conducted some staff training on food storage, and stated they will conduct additional training on food storage. LPA interviewed two clients and did not obtain information about any additional food concerns at the facility. The information obtained corroborated the allegation.

Regarding the allegation that facility staff are not properly trained: it was alleged that multiple staff did not have documentation of required annual training and that staff did not have required inhaler training. LPA interviewed PM who denied the allegation. LPA reviewed the staff training records for six staff and confirmed they all have documentation of required training. However, PM admitted that there is a restricted health condition care plan for a client with an inhaler and that not all staff were trained on the restricted health condition. LPA reviewed staff training records and the facility’s staff schedule and noted that on February 4, 5, and 6, 2025, during the overnight shift, there was no staff on duty who had completed the inhaler training. The information obtained corroborated the allegation.

Regarding the allegation that facility staff did not ensure clients received medical services: it was alleged that clients did not receive the recommended number of consultation hours from medical providers. LPA interviewed two clients who did not raise concerns regarding the outside medical services they are receiving. LPA interviewed PM who admitted the allegation, stating that both clients have not received the required number of hours from their medical consultants. LPA reviewed C1’s Service Plan, which states C1 should be getting four hours of psychiatric services per month, but C1’s Consultant Log shows C1 only received three and a half hours of psychiatric services in February 2025. LPA reviewed C2’s Service Plan, which states C2 should be getting one hour of primary care services per month, but C2’s Consultation Log shows C2 did not receive any hours of primary care services between October 2024 and January 2025. The information obtained corroborated the allegation.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20250407093310
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: NANTUCKET HOME
FACILITY NUMBER: 306005891
VISIT DATE: 04/09/2025
NARRATIVE
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Regarding the allegation that facility staff are not administering medications as prescribed: it was alleged that the facility did not administer C1’s as-needed laxatives as prescribed. LPA interviewed two clients who did not raise concerns about their medications. LPA interviewed PM who admitted the allegation, stating C1 has a doctor’s order which states that if C1 has not had a bowel movement for one day, the facility is to give C1 an as-needed laxative, but that staff had not always administered these laxatives as ordered. LPA reviewed C1’s Bowel Movement Log which shows C1 did not have a bowl movement on February 1, 2, 3, and 4, 2025, and C1’s Medication Administration Records which show that although C1 received their routine laxatives as ordered, C1’s as-needed laxative was not given on February 2, 2025, as ordered. The information obtained corroborated the allegation.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20250407093310
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: NANTUCKET HOME
FACILITY NUMBER: 306005891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2025
Section Cited
CCR
80076(a)(1)
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80076 Food Services (a) In facilities providing meals to clients, the following shall apply: (1) ... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by:
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Licensee stated they will conduct staff training on proper food storage and submit proof to LPA by POC due date.
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Based on observation and admission, the licensee did not ensure cookies and a jar of food were properly sealed while being stored, which poses a potential health risk to persons in care.
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Type B
05/07/2025
Section Cited
CCR
80075(b)(1)
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80075 Health Related Services (b) …. (1) In adult CCFs, facility staff who receive training may assist clients with metered-dose inhalers, and dry powder inhalers if the following requirements are met… This requirement was not met as evidenced by:
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Licensee stated they will conduct inhaler training and submit proof to LPA by POC due date.
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Based on documents and admission, the licensee did not ensure there were staff on every shift that were trained to assist clients with inhalers if needed, which poses a potential health risk to persons in care.
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This is an amended report.
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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20250407093310
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: NANTUCKET HOME
FACILITY NUMBER: 306005891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/07/2025
Section Cited
CCR
80075(a)
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80075 Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services… This requirement was not met as evidenced by:
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Licensee stated will submit a plan to ensure clients are receiving the required number of medical service hours per month to LPA by POC due date.
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Based on documents and admission, the licensee did not ensure both clients received the total number of required medical service hours per month, which poses a potential health risk to persons in care. CIVIL PENALTY ASSESSED.
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Type B
05/07/2025
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 was not met as evidenced by:
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Licensee stated they will conduct medication training and submit proof to LPA by POC due date.
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Based on documents and admission, the licensee did not ensure C1 received assistance with medications when C1 was not given their as-needed laxative as ordered, which poses a potential health risk to persons in care.
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This is an amended report.
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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7