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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006074
Report Date: 04/03/2024
Date Signed: 04/03/2024 04:28:15 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, 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
03/27/2024 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240327153343
FACILITY NAME:SUCCESSFUL PEOPLE LLC #5FACILITY NUMBER:
306006074
ADMINISTRATOR:SNODDY, FRANCESFACILITY TYPE:
735
ADDRESS:1774 W CHALET AVETELEPHONE:
(310) 902-4893
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:4CENSUS: 4DATE:
04/03/2024
UNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Adrianna HarbinTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff speak inappropriately to residents

Untrained staff administering medications

Uncleared adults working at the facility
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above. LPA met with Assistant Administrator (AAD) Adrianna Harbin and explained the purpose of the inspection.

Interviews were conducted with four facility staff and four out of four clients regarding the allegation staff speak inappropriately to residents. Four out of four staff denied personally speaking inappropriately to clients and denied witnessing any other staff speaking inappropriately to clients. Three out of four clients denied being spoken to inappropriately by staff and denied witnessing staff speaking inappropriately to other clients. One out of four clients was unable to confirm or deny whether staff speak inappropriately to them or other facility clients.

(Cont. LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
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 2
Control Number 22-AS-20240327153343
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: SUCCESSFUL PEOPLE LLC #5
FACILITY NUMBER: 306006074
VISIT DATE: 04/03/2024
NARRATIVE
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Interviews were conducted with four facility staff and four out of four clients regarding the allegation untrained staff are administering medications. Three out of four clients stated they receive assistance with self administered medication but were unable to confirm or deny if staff are trained to administer medication. One out of four clients was unable to confirm or deny whether they receive assistance with medication or if staff are trained to administer medication. Four out of four staff interviewed reported staff is trained prior to assisting clients with medication and confirmed they themselves were given on-the-job medication training prior to assisting clients with medication. LPA obtained picture copies of on-the-job medication training logs for three out of four staff. Training logs indicate staff were given on-the-job-medication training within the first 40-hours of being hired. Per documentation, medication training consists of administering and maintaining a log of medications, using sterile procedures, proper storage of medication and side effects. One of the four staff interviewed started working at the facility on today’s date. Per staff, they have not administered any medication and have only observed thus far.

Interviews were conducted with four facility staff and four out of four clients regarding the allegation uncleared adults working at the facility. Four out of four staff could not corroborate allegation and confirmed they had to be background checked and cleared prior to working at the facility. Upon arrival, LPA witnessed a staff meeting taking place at the facility and confirmed all staff present were background checked, cleared, and associated to the facility. Four out of four clients interviewed could also not corroborate allegation and were unable to confirm or deny if any uncleared adults were working at the facility.

Due to conflicting information received during interviews conducted, and after a review of facility staff medication training log, staff roster, and Guardian association list, LPA is unable to determine if staff speak inappropriately to residents, if untrained staff are administering medications, or if uncleared adults were working at the facility. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated.

An exit was conducted and copy of this report was provided at the end of the inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2