197608233-5-29-2021-11-AS-MVAO-C3MLPL-20210603085608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608233
Report Date: 05/28/2021
Date Signed: 05/29/2021 11:44:37 AM

Unsubstantiated

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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210329112836

FACILITY NAME:	AMAZING PARADISE HOME CARE		FACILITY NUMBER:	197608233
ADMINISTRATOR:	YOLANDA BERNARDO		FACILITY TYPE:	740
ADDRESS:	312 WEST 229TH STREET		TELEPHONE:	(310) 549-9888
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	6	CENSUS: 5	DATE:	05/28/2021
		UNANNOUNCED	TIME BEGAN:	12:13 PM
MET WITH:	YOLANDA BERNARDO		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff inappropriately touched the resident.
Resident sustained injuries while in care.
Staff failed to meet the resident's needs.

INVESTIGATION FINDINGS:

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On 05/28/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. LPA met with Yolanda Bernado Administrator. (LPA) Dabuet explained the purpose of today's visit is to deliver findings and conduct an inspection of the facility.

The investigation consisted of the following: LPA interviewed staff (S1-S3), residents (R1-R9), and witnesses (W1-W11) from this facility and multiple facilities associated with this licensee. LPA inquired questions relevant to the nature of the complaint allegations. A review of (R1)'s and (S1)'s service records and other pertinent documents related to this investigation. A tour of this facility, A Paradise Elderly Home, and Asahi Residential Care.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

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 11-AS-20210329112836

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: AMAZING PARADISE HOME CARE	FACILITY NUMBER: 197608233
	VISIT DATE: 05/28/2021

NARRATIVE

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The facility Administrator conducted its own Internal Investigation on 03/28/21. The facility notified Community Care Licensing (CCL) of the incident on 03/28/21. The Department contacted Law Enforcement and was informed that no report was taken as there were no life-threatening physical signs that would constitute elder assault or abuse. A plant inspection was conducted and found the facility does not have video surveillance equipment installed.

The investigation consisted of an inspection of the multiple facilities associated with the licensee, observation, review of services records, internal investigation report, and interviews with residents from multiple facilities were conducted all resulted in no elder neglect or abuse of the persons in care at this licensed facility.

Based on information gathered, the Department did not find sufficient evidence to support the allegations: "Staff inappropriately touched the resident", "Resident sustained injuries while in care", “Staff failed to meet the resident's needs”.

Although the allegations may have happened or are valid, there is not enough preponderance of evidence to prove the alleged allegations are valid did or did not occur. Therefore, the allegations are "unsubstantiated.

No deficiencies were cited.

An exit interview was conducted with Yolanda Bernardo, and a hard copy was provided by email.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210329112836

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: AMAZING PARADISE HOME CARE	FACILITY NUMBER: 197608233
	VISIT DATE: 05/28/2021

NARRATIVE

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Allegation: Staff inappropriately touched the resident.

It is alleged Resident #1 (R1) was improperly touched by staff. Interviews were conducted with residents #1-#9 (R1-R9) staff #1-#3 (S1-S3), witnesses #1-#9 (W1-W11), and found there is no evidence to corroborate the above allegation. The Department obtained (R1’s) service records in which included: Preplacement Appraisal, Progress Notes, Emergency Form, Medication List, Physician’s Report, and Unusual Incident/Injury Reports. In addition, (S1’s) personnel files were provided and accounted for, and reviewed.
Resident #1 (R1) was admitted at this facility on 10/04/20 through 03/31/21 was being assisted with personal activities of daily living. It was alleged that (S1) had improperly touched (R1) on 03/27/21 while being assisted with showering. An interview on 05/12/21 with (S1) who is employed at Amazing Paradise Home Care and A Paradise Elderly Home denied having any knowledge or being involved with (R1) in any improper physical contact. An interview with (R1) on 05/12/21, was unable to provide or recall any information in which involves any unwelcome behavior from (S1). An interview with the administration (S2) revealed that an internal investigation was conducted on 03/28/21 and spoke with (R1) and (S1) and both parties had denied the accusation and had no witnesses to validate these accusations. (R1) reported that no physical, sexual, or harassment was done and stated this was all misunderstanding. The Department interviewed with (W2-W11) and no one was able to support this claim. Interviews with residents (R2-R5) from Amazing Paradise Home Care and residents (R6-R9) from A Paradise Elderly Home revealed no such improper behavior has ever been experienced with (S1) or any other staff members. An interview with (W1-W2) both claimed they failed to file a police report with law enforcement for elder abuse. Based on information gathered there is no evidence to support the allegation of “Staff inappropriately touched the resident”.

Allegation: Resident sustained injuries while in care.

It is alleged Resident #1 (R1) sustained injuries while in care. Interviews were conducted with residents #1-#9 (R1-R9) staff #1-#3 (S1-S3), witnesses #1-#9 (W1-W11), and a review of (R1)’s service records and Unusual Incident/Injury Reports and found there is no evidence to support the above allegation.
An interview with (R1) was unable to provide an accurate date and time when this alleged incident occurred or recall such incident.

Evaluation Report continues on LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210329112836

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: AMAZING PARADISE HOME CARE	FACILITY NUMBER: 197608233
	VISIT DATE: 05/28/2021

NARRATIVE

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According to (W2), (R1) was not sent for medical attention to validate such physical trauma was caused for bruises or marks on (R1’s) forearms. In an interview with (S1-S3) all denied (R1) had suffered bruises produced by a fall or physical abuse. (S1-S3) reports that (R1) is on medications that cause side effects on the skin and are on blood thinner twice daily which increases the risk of bleeding and may bruise more easily. (S1-S3) reports that body checks are conducted daily and any relevant bruises would have been reported or indicated on (R1)’s progress notes. According to the Administrator (S1) when conducting an internal investigation, both (R1) and (S1) had denied this accusation. The Department interviewed with (W2-W11) and no one was able to support this claim. Interviews with residents (R2-R5) from Amazing Paradise Home Care and residents (R6-R9) from A Paradise Elderly Home revealed that residents have not sustained any injuries while being care for by (S1) or any other staff. An interview with (W1-W2) both claimed they did not file a police report with law enforcement for elder abuse. Based on information gathered there is no evidence to support the allegation of “Resident sustained injuries while in care”.

Allegation: Staff failed to meet the resident's needs.

It is alleged Resident #1 (R1) needs are not being met. Interviews were conducted with residents #1-#9 (R1-R9) staff #1-#3 (S1-S3), witnesses #1-#9 (W1-W11), and a review of (R1)’s service records and Unusual Incident/Injury Reports and found there is no evidence to support the above allegation.

An interview with (R1) was not able to provide information on what needs are not being provided. According to (S1-S3) this accusation is false and that (R1) daily needs are being met adequately. The accusations that (R1) was dirty, unshaven, and disheveled are untrue according to staff. An interview with (W3) who provides additional care to (R1) every week states that she has never observed the (R1) in a deplorable condition. The Department interviewed with (W4-W11) and no one was able to support this claim. Interviews with residents (R2-R5) from Amazing Paradise Home Care and residents (R6-R9) from A Paradise Elderly Home revealed that residents’ needs are being provided sufficiently and that staff is attentive to residents' needs. An interview with (W1-W2) both claimed they did not file a police report with law enforcement for elder neglect. Based on information gathered there is no evidence to support the allegation of “Staff failed to meet the resident's needs”.

Evalutation Report continues on LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021

LIC9099 (FAS) - (06/04)

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