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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005943
Report Date: 10/06/2021
Date Signed: 10/06/2021 05:14:12 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
05/24/2021 and conducted by Evaluator Michelle Reed
COMPLAINT CONTROL NUMBER: 22-AS-20210524191647
FACILITY NAME:MANDEL HOUSEFACILITY NUMBER:
306005943
ADMINISTRATOR:MCDONALD, LISAFACILITY TYPE:
735
ADDRESS:2220 CONCORD STREETTELEPHONE:
(818) 782-2211
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY:6CENSUS: 3DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator Yvette DoranTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Illegal Eviction
Facility does not have a qualified Administrator
Staff not trained for restricted health condition
Provider did not transport client to school
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Yvette Doran. The complaint consisted of interviews with Chief Executive Officer Kimberly Lee, witnesses and a review of records. The following was determined:

Client #1 (C1) was admitted into Mandel House in December of 2019. In April of 2021 there was a change of ownership. C1 left the facility and then returned on 5/3/21. Records reviewed disclosed that C1 had a history of physical aggression and elopement. On 5/22/21 C1 returned from an outing and was agitated. C1 began cursing at S1 and threw punches, spit, kicked and bit S1. S1 had to hold C1’s arms to stop the attack. C1 then headbutted S1 and they both fell to the floor. C1 obtained a cut on his forehead and S1 was bleeding by the mouth. S1 had to hold C1 down on the floor so that C1 would not punch or bite him again. Chief Executive Officer Kimberly Lee contacted C1's responsible party to pick up C1 and find another facility. Responsible party took C1 home for weekend and C1 was moved to another facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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 22-AS-20210524191647
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: MANDEL HOUSE
FACILITY NUMBER: 306005943
VISIT DATE: 10/06/2021
NARRATIVE
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On 6/1/21 LPA asked to review facility records. Per Kimberly Lee there were no staff records at the facility to review. The facility did not have a qualified administrator or proof of staff training. There was no training for staff on restricted health conditions and C2 has a BiPAP machine. Designated Administrator Lisa McDonald resigned as of late April, early May 2021. Her position was not filled. According to Ms. Lee she was finishing up her Administrator training and would be applying for her certificate. Yvette Doran was appointed Administrator as of 6/30/21.

C1 was also supposed to attend school during the week. According to staff interviewed, C1 did not attend school for about a week upon his return to the facility as there was a lack of staffing.

Based upon records and interviews, The preponderance of evidence standard has been met and the above allegations are substantiated.

See attached LIC9099D for cited deficiencies per California Code of Regulations, (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report and appeal rights were provided to Administrator Yvette Doran.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20210524191647
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: MANDEL HOUSE
FACILITY NUMBER: 306005943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2021
Section Cited
CCR
80068.5(b)
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Eviction Procedures-The licensee shall obtain prior written approval from the Department to evict the client upon three (3) days written notice to quit and upon a finding of good cause.

This requirement was not met as evidenced by:
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Licensee/Administrator agrees to review eviction procedures and ensure that they are followed anytime an eviction may need to occur. Proof of understanding of this CCR section will be provided in writing by POC date.
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Licensee evicted resident without a 3 day or 30 day notice. Client was told that he may not return to facility on 5/22/21 and was sent home with responsible party. This is an immediate personal rights risk to residents in care.
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Type A
10/07/2021
Section Cited
CCR
85064(b)
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Administrator Qualifications and Duties- All adult residential facilities shall have a certified administrator.


This requirement was not met as evidenced by:
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Licensee agrees to notify Licensing within 30 days when there is a change of Administrator. Required forms shall also be provided.
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Licensee did not have a qualified Administrator. Administrator Lisa McDonald resigned in late April, early May of 2021. A qualified substitute was not put into place and a new Administrator was not hired until 6/23/21. This is an immediate health and safety risk as there was no oversight of facility.
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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: Michelle Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20210524191647
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: MANDEL HOUSE
FACILITY NUMBER: 306005943
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/06/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/07/2021
Section Cited
CCR
80092.1(f)(2)(A)
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General Requirements for Restricted Health Conditions-Prior to admission of a client with a restricted health condition, the licensee shall: Ensure that facility staff complete training provided by a licensed professional sufficient to meet those needs. Training shall include hands-on instruction in both general procedures and client specific procedures.
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Licensee shall ensure that all staff are trained on any restricted health conditions that residents have. Training for R2 shall be completed immediately with all staff and proof provided. All new facility staff who will participate in meeting the client’s specialized care needs shall complete the training prior to providing services to the client.
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This requirement was not met as evidenced by:

C2 has a Bipap machine and staff training could not be provided. Licensee did not have any staff training available for LPA's review on 6/1/21. This is an immediate health and safety risk.
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Type A
10/07/2021
Section Cited
CCR
85065(b)
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Personnel Requirements-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:


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Licensee shall ensure that there are always enough staff to meet the care of residents. Licensee agrees to provide certification that enough staff will always be present to meet the needs of all clients.
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Interviews disclosed that C1 was not taken to school for a week when he returned 5/3/21 as there were not enough staff present at the facility. This is an immediate personal rights violation.
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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: Michelle Reed
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4