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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609943
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:49:08 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
07/14/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210714154341
FACILITY NAME:JOCELYN'S LOVING CAREFACILITY NUMBER:
197609943
ADMINISTRATOR:ESPIRITU, JOCELYNFACILITY TYPE:
740
ADDRESS:803 N GENESEE AVETELEPHONE:
(323) 592-3100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY:6CENSUS: 4DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jocelyn & Christopher EspirituTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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1. Staff did not fill/reorder resident's medications for an extended period of time
2. Staff did not give resident medications according to physicians' orders
3. Resident is paying for services not received
4. Facility did not maintain a resident's medication list
5. Staff member made an inappropriate comment to resident
6. Staff member pushed resident resulting in resident falling
7. Resident is paying for services not received
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit, to deliver the final findings of the allegations mentioned above. LPA met with Administrators Jocelyn and Christopher Espiritu, who was informed the reason of the visit. The following was determined:

Allegation # 1: Staff member pushed resident resulting in resident falling. On July 26, 2021, from 930am to 1245pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews and reviewed facility and resident records. Based on information obtained, resident # 1 (R1) tried to hit staff # 1 (S1) with a shovel. S1 attempted to block R1 from being hit with the shovel, and in the process of blocking the shovel, S1 inadvertently bumped R1, causing R1 to fall on the ground. Both R1 and S1 are no longer at the facility, so that LPA was not unable to obtain interviews; and current residents and staff did not witness the incident. Therefore, based on interviews and documentation, the allegation is deemed UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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 4
Control Number 31-AS-20210714154341
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: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 10/20/2022
NARRATIVE
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Allegation # 2: Facility does not provide a comfortable environment for resident. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records, and conducted a physical plant inspection. Based on today’s observations, and information obtained from staff and residents, the facility is always comfortable for residents, and the temperature met Licensing regulations. Therefore, based on today’s observations, and physical plant inspection, the allegation is deemed UNSUBSTANTIATED.

Allegation # 3: Staff member made an inappropriate comment to resident. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. Through information obtained, LPA determined that resident # 1 (R1) caused tension and conflict with staff and other residents while living at the facility. LPA reviewed numerous incident reports, pertaining to the behavior of R1. Residents and staff who were present when R1 was at the facility, are gone, so LPA was not able to obtain further information. Current staff and residents did not witness the alleged inappropriate comment. Therefore, based on interviews and documentation, LPA determined the allegation is UNSUBSTANTIATED at this time.

Allegation # 4: Facility did not maintain a resident's medication list. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. LPA observed the facility maintained resident # 1 (R1's) medication list and reviewed documentation from R1’s primary physician regarding the medication that was to be discontinued. LPA also obtained the medication administration record (MAR) obtained by the facility for R1. LPA observed no discrepancies, therefore, based on record review, LPA determined the allegation is UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20210714154341
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: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 10/20/2022
NARRATIVE
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Allegation # 7: Resident is paying for services not received. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. Information obtained and from interviews conducted, staff documented numerous incidents regarding the behavior and issues with resident #1 (R1) while in the care at the facility. It was also reported to LPA that R1 did not pay for rent for (4) months. LPA reviewed all documentation, and determined that the facility provided all services that was written in the admission agreement. LPA also determined there is insufficient evidence to prove the allegation, therefore, based on documentation and interviews, the allegation is UNSUBSTANTIATED at this time.

Exit interview and copies of report provided.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 31-AS-20210714154341
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: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 10/20/2022
NARRATIVE
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Allegation # 5: Staff did not fill/reorder resident's medications for an extended period of time. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. It was revealed to LPA by Administrators, that resident # 1 (R1) would drive to doctor visits alone without staff. R1 would not report or provide documentation such as any new physician or medication orders. Administrators attempted on several occasions to obtain medical information for R1. Administrators were denied any access to records and was instructed to obtain documentation from R1. R1 refused, therefore staff were not aware of current medical information for R1. It was also reported, that when staff cleaned R1’s private room, they found new medication RX’s and physician notes. Therefore, LPA determined, that R1 intentionally withheld medical information from staff, and medication stored by the facility was administered according to physician's orders. LPA was not able to interview R1, due to R1 no longer residing at the facility. Based on documentation and interviews, LPA determined there is insufficient evidence to prove the allegation, and it’s deemed UNSUBSTANTIATED at this time.

Allegation # 6: Staff did not give resident medications according to physicians' orders. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. It was revealed to LPA by staff, that resident # 1 (R1) would drive to doctor visits alone without staff. R1 would not report or provide documentation such as physician or new medication orders. Administrators attempted on several occasions to obtain medical information for R1. Administrators were denied any access to records and was instructed to obtain documentation from R1. R1 refused, therefore staff were not aware of current medical information. It was also reported, that when staff cleaned R1’s private room, they found new medication RX’s and physician notes. Therefore, R1 intentionally withheld medical information. LPA was not able to interview R1, due to R1 no longer residing at the facility. Based on documentation and interviews, LPA determined there is insufficient evidence to prove the allegation, therefore the allegation is deemed UNSUBSTANTIATED at this time.
SUPERVISORS NAME: Cassandra Harris
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4