198602394-9-22-2021-28-AS-LHIS-C7HPRF-20211005113239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602394
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:20:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/17/2019 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191017094242

FACILITY NAME:	DOWNEY HOME		FACILITY NUMBER:	198602394
ADMINISTRATOR:	MILIAN, GURITH		FACILITY TYPE:	735
ADDRESS:	11403 HORTON AVENUE		TELEPHONE:	(562) 682-2417
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	4	CENSUS: 4	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Assistant Administrator, Maricela Rodriguez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff falsifying documents
Staff is mismanaging resident's medication.
Staff failed to provide a safe environment
Facility has Insufficient staff to meet the resident's needs
Staff withholding residents allowance money
Insect infestation present at facility
Night staff is sleeping during their shift
Facility has a poor quality of food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Assistant Administrator, Maricela Rodriguez who assisted with today's visit.

Regarding the allegation(s) that : Staff are falsifying documents and Staff is mismanaging resident's medication, the investigation consisted of interview with Assistant Administrator, and House manager, and review of residents medication and medication records, on initial visit, and on today's visit. Staff interviewed denied the allegation. LPA did not observe that staff was falsifying documents and was not mismanaging resident's medication.

Regarding the allegation that: Staff failed to provide a safe environment, specifically that staff does not provide any activities for the residents and they consistently gain weight. The investigation consisted of interviews with Assistant Administrator, and House manager and review of resident weight logs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191017094242

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY HOME	FACILITY NUMBER: 198602394
	VISIT DATE: 09/22/2021

NARRATIVE

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Staff interviewed denied the allegation. Staff stated that residents have activities, and denied that residents are consistently gaining weight. LPA reviewed resident weight logs on initial visit, and on today's visit, and did not observe that residents are gaining weight.
weight.

Regarding the allegation that facility has Insufficient staff to meet the resident's needs: The investigation consisted of interviews with Assistant Administrator, and House manager and review of staff roster, and staff schedule. Staff interviewed denied the allegation. LPA observed that there are two staff on schedule at the facility during the day, and one staff is on schedule at the facility during the night. None of the residents residing at the facility require a one to one staff to resident ratio.

Regarding the allegation that staff is withholding residents allowance money. The investigation consisted of interviews with Assistant Administrator, and House manager and review of residents P & I ledger(s). Staff interviewed denied the allegation. LPA reviewed resident P & I ledgers on initial visit, and on today's visit. LPA did not observe that staff are withholding residents P & I money.

Regarding the allegation that there is an insect infestation present at facility. The investigation consisted of interviews with Assistant Administrator, and House manager and tour of facility on initial visit, and on today's visit. Staff interviewed denied the allegation. LPA did not observe any insects at the facility on either visit.

Regarding the allegation that Night staff is sleeping during their shift. The investigation consisted of interviews with Assistant Administrator, and House manager. Staff interviewed denied the allegation. Staff stated that night shift staff have duties to complete during their shift, and they have not had any reports that staff are sleeping during their shift.

Regarding the allegation that the facility has a poor quality of food: The investigation consisted of interviews with Assistant Administrator, and House manager, and review of facility food supply on initial visit, and on today's visit. Staff interviewed denied the allegation. LPA observed that the facility had a good quality and sufficient amount of food on initial visit, and on today's visit.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191017094242

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DOWNEY HOME	FACILITY NUMBER: 198602394
	VISIT DATE: 09/22/2021

NARRATIVE

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Based on LPA's observations and interviews, investigation revealed: Although the 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 the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator, Maricela Rodriguez.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

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