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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191800897
Report Date: 11/26/2024
Date Signed: 11/26/2024 03:59:12 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/21/2024 and conducted by Evaluator Tyler Reyes
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241121112926
FACILITY NAME:ANNE SIPPI CLINICFACILITY NUMBER:
191800897
ADMINISTRATOR:OLGA RECENDEZFACILITY TYPE:
735
ADDRESS:2457 ENDICOTT ST.TELEPHONE:
(323) 221-5177
CITY:LOS ANGELESSTATE: CAZIP CODE:
90032
CAPACITY:37CENSUS: 40DATE:
11/26/2024
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Lead Floor Supervisor Robert HerediaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff are interfering with residents ability to recieve visitors and communicate with family.
Facility does not provide clients access to a working telephone.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tyler Reyes conducted a complaint investigation for the allegations facility staff are interfering with residents ability to recieve visitors and communicate with family and facility does not provide clients access to a working telphone. LPA arrived unannounced and met with Lead Floor Supervisor Robert Heredia and explained the purpose of the visit.

LPA's investigation consisted of the following:
LPA conducted interviews with Lead Floor Supervisor Robert, Clients #1 -5 (C1-C5), and Staff #1 – 4 (S1-S4). LPA obtained copies of the documents from C1and C5's conservatorship, On-Site Visit Form, Home Pass/Outing Form and House Rules and Regulations.

--Continued LIC 9099-C--

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
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 4
Control Number 28-AS-20241121112926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ANNE SIPPI CLINIC
FACILITY NUMBER: 191800897
VISIT DATE: 11/26/2024
NARRATIVE
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Investigation revealed the following: Regarding allegation, Facility staff are interfering with residents’ ability to receive visitors and communicate with family. (3) of (4) staff confirmed the allegation. Staff indicated that facility requires visitors to schedule visits 24 hours in advance, citing this as part of their visitation policy. During this time, staff verify with the client’s conservator to determine whether the visitor is allowed. Staff do not verify whether the client’s conservator has the authority to approve or deny visitation and instead rely solely on the conservator’s statement regarding authorization. (2) of (5) clients confirmed the allegation. Client indicated that they are permitted to have visitors if visitors make an appointment a day in advance. LPA observed copies of On-Site Visit Form and Home Pass/Outing Form. Both forms contain a section to be completed of the Day, Date, and Time of visit. LPA observed the wall of inside the medication room containing the upcoming scheduled visitations.

Investigation revealed the following: Regarding allegation, Facility does not provide clients access to a working telephone. (4) of (4) staff confirmed the allegation. Staff indicated that between the hours of 8AM – 4PM clients are permitted to use the front office and staff lounge telephone. After the 4PM the clients are required to use the payphone located inside the facility. Clients do not receive money from the facility, and are required to make collect calls for any local calls. (5) of (5) clients confirmed the allegation. Clients indicated that any telephone calls need to make before 4PM. No client has stated receiving money from the facility to use the payphone. Clients have indicated multiple issues completing their calls when using the phone. LPA and LPA’s manager dialed the telephone number provided by the Lead Floor Supervisor Robert as the callback number (323)343-8645 for the payphone twice at 11:11AM. Both attempts resulted in busy signal. LPA used the payphone to dial their work phone and noted that the number displayed was different from the callback number provided by Lead Floor Supervisor Robert. When LPA redialed using the correct number, the call resulted in a continuous ring and with a forwarding message of "error 48".

LPA provided Lead Floor Supervisor Robert with ASSEMBLY BILL 937 (Wieckowski), Chapter 127, Statutes of 2013 for reference regarding conservatorship. Effective January 1, 2014, the Probate Code shall be amended to state that a conservator’s authority shall not infringe on a conservative’s personal rights, including, but not limited to, the right to receive visitors, telephone calls, and personal mail, unless specifically limited by a court order. This law only applies to full conservatorships and not to limited conservatorships.


--Continued LIC 9099-C--
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20241121112926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ANNE SIPPI CLINIC
FACILITY NUMBER: 191800897
VISIT DATE: 11/26/2024
NARRATIVE
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The investigations revealed that the facility requires visitors to schedule visitation appointments 24 hours in advance, during which staff verify with the conservator to approve or deny visitation without confirming the conservator’s legal authority. After 4PM clients are required to use the payphone for all calls. Clients have reported to having issues with the pay phone, including difficulties completing local calls and having to pay. Testing of the pay phone revealed discrepancies in the callback number listed and technical issues, such as continuous ringing and errors, further limiting access to a functional telephone.

Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interviewed conducted with Lead Floor Supervisor Robert and a copy of this report was provided with appeal rights

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20241121112926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ANNE SIPPI CLINIC
FACILITY NUMBER: 191800897
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/03/2024
Section Cited
CCR
85072(b)(9)
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85072 (b) The licensee shall insure that each client is accorded the following personal rights. (9) To have access to telephones in order to make and receive confidential calls, provided that such calls do not infringe upon the rights of other clients and do not restrict availability of the telephone during emergencies. The requirment is not met evidence by .
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Administrator will ensure clients have access to a telephone in order to make and recieve confidential calls. Adminstrator will provide proof clients have access to an operational telphone that requires no money and can make and receive telephone calls.
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Based on interviews and observations clients indicated that any telephone calls need to make before 4PM. No client has stated receiving money from the facility to use the payphone for local calls. Clients have indicated multiple issues completing their calls when using the phone. LPA used the payphone to dial their work phone and noted that the number displayed was different from the callback number provided by Lead Floor Supervisor Robert. When LPA redialed using the correct number, the call resulted in a continuous ring and with a forwarding message of "error 48" which poses a potential health, safety or personal rights risk to persons in care.
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Type B
12/03/2024
Section Cited
CCR
85072(b)(4)
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85072 (b) The licensee shall insure that each client is accorded the following personal rights (4) To have visitors, including advocacy representatives, visit privately during waking hours, provided that such visitations do not infringe upon the rights of other clients. The requirment is not met evidence by
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Administrator will ensure clients are allowed visitors during waking hours without visitors having to schedule a visit with facility.
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Based on interviews Staff indicated that facility requires visitors to schedule visits 24 hours in advance, citing this as part of their visitation policy. During this time, staff verify with the client’s conservator to determine whether the visitor is allowed. Staff do not verify whether the client’s conservator has the authority to approve or deny visitation and instead rely solely on the conservator’s statement regarding authorization which poses a potential health, safety or personal rights risk to persons 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: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4