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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601529
Report Date: 04/06/2022
Date Signed: 04/06/2022 04:59:18 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2022 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20220401132514
FACILITY NAME:HIGHLAND PARK GUEST HOME, INC.FACILITY NUMBER:
198601529
ADMINISTRATOR:ROBERT S. IVES JRFACILITY TYPE:
735
ADDRESS:345 N. AVE 57TELEPHONE:
(323) 529-4267
CITY:LOS ANGELESSTATE: CAZIP CODE:
90042
CAPACITY:40CENSUS: DATE:
04/06/2022
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria Lopez, ManagerTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Client's belongings not being safeguarded.

Client is not being provided their PNI funds.

Staff inappropriately disciplines clients in care.

Facility staff negligence contributed to client's death.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint investigation for the above noted allegations. LPA met with Maria Lopez, Manager and discussed the purpose of the visit.

It was reported that Client #1's (C1's) belongings are not being safeguarded. To investigate this allegation, LPA interviewed staff. Staff interviews revealed that C1 does not allow staff into their room. In addition, C1 changed the locks to the room and only they have the key. LPA spoke to C1 and they were unable to provide any credible information to confirm that their belongings were not safeguard. On 04/06/22 at 3:05pm, LPA reviewed C1's inventory and it does not list any items. C1 signed the document indicating that they had no personal belongings.

Based on interviews and record review this allegation is deemed UNSUBSTANTIATED at this time.

Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
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 2
Control Number 31-AS-20220401132514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: HIGHLAND PARK GUEST HOME, INC.
FACILITY NUMBER: 198601529
VISIT DATE: 04/06/2022
NARRATIVE
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It was alleged that C1 is not being provided PNI funds. To investigate this allegation, LPA interviewed staff. Staff interviews revealed that C1 receives their own money from Social Security and that it is deposited directly to their account. C1 pays their rent with a personal check. The facility does not have access to C1's bank account. On 04/06/22 at 3:15pm, LPA reviewed copies of C1's personal cashed checks. LPA confirmed that C1 pays their rent through their own bank account.

Based on interviews and record review this allegation is deemed UNSUBSTANTIATED at this time.

It was reported that staff inappropriately discipline clients in care. To investigate this allegation, LPA interviewed staff and clients between 2:45pm and 3:30pm. Staff interviews revealed that staff do not discipline clients, but they do remind them of the facilities rules. Smoking is not allowed on the facility premises, but clients can go out to the street and smoke. Clients confirmed that smoking can be done on the sidewalk and that staff treat them with dignity and respect. Also, LPA observed staff to be respectful towards clients.

Based on interviews and observation this allegation is UNSUBSTANTIATED at this time.'

It was alleged that facility staff negligence contributed to a client's death. To investigate the allegation, LPA Valenzuela interviewed staff and clients between 2:25pm and 3:30pm. Staff interviews revealed that no recent deaths have occurred at the facility. The last death that occurred at the facility was about 15 years ago. Furthermore, LPA conducted a review of the Serious Incident Reports (SIRs) and did not see any reports notifying licensing of any deaths. LPA also interviewed facility clients. Ten percent of clients were interviewed. Interviews revealed that clients have not heard that any clients have passed away at the facility either in the past or currently.

Based on the information obtained through interviews and record review, this allegation is UNSUBSTANTIATED at this time.

Exit interview conduct and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2