198320041-9-13-2023-11-AS-MVAO-CXKRVR-20231114122156

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320041
Report Date: 09/13/2023
Date Signed: 09/13/2023 12:10:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/10/2023 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230810130243

FACILITY NAME:	GOOD HANDS HOMECARE		FACILITY NUMBER:	198320041
ADMINISTRATOR:	PORCA, MICHELLE ANN		FACILITY TYPE:	740
ADDRESS:	105 W. 225TH STREET		TELEPHONE:	(310) 422-0950
CITY:	CARSON	STATE: CA	ZIP CODE:	90745
CAPACITY:	6	CENSUS: 6	DATE:	09/13/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Michelle Porca		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Illegal Eviction
Staff did not observe resident had open wound
Staff did not disclose to POA resident's health condition

INVESTIGATION FINDINGS:

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On 09/13/2023 at 8:00 am, Licensing Program Analyst (LPA) David España conducted an unannounced complaint visit at this facility, LPA was greeted by S4 and later Administrator Michelle Porca. LPA explained the purpose of the visit is to investigate the allegation mentioned above. LPA conducted a risk assessment at the entrance of the facility, and there are no COVID-19 cases at this time. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for six (6) hospice residents. Currently, there are four (4) hospice residents in care. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident's rooms, one (1) staff room, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside patio area. LPA and licensee toured the physical plant. The investigation consisted of the following: LPA España conducted a tour of the facility grounds. LPA España interviewed staff and noted the reviewed records. LPA España requested and reviewed the following documents, client roster and staff roster. LPA Investigation spans from 08/15/2023; 08/28/2023; and 09/13/2023. Report continued on LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

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 11-AS-20230810130243

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD HANDS HOMECARE	FACILITY NUMBER: 198320041
	VISIT DATE: 09/13/2023

NARRATIVE

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Allegation: Illegal Eviction
At 8:00 am LPA reviewed documentation from past visit(s) 08/15/2023 and 08/28/2023, namely, Staff 1-4 (S1-S4) who were interviewed as S1 had no knowledge of the eviction and referred to case manager (unknown name) and complainant, as being all called and informed. LPA spoke to S1 regarding the alleged illegal eviction. The Administrator stated R1’s POA and case manager were informed. The Administrator further stated R1 was not evicted because R1 had higher level of care requirements.

S1 stated there was no eviction issued. LPA noted two different statements on 08/15/2023: (1) Administrator did speak with R1’s POA and case manager about relocating R1 and (2) the Administrator did not provide an eviction notice. Residents 1, 2, 3, 5, 6, 7 (R1-R3 and R5-R7) all have dementia and are nonverbal. Resident 4 (R4) is verbal. LPA on 08/28/2023 and 09/13/2023 did not observe an eviction notice(s) copy as requested.

LPA on 08/28/2023 and 09/13/2023 did not observe unlawful detainer action from the Superior Court. LPA on 08/28/2023 and 09/13/2023 observed no written judgment. LPA on 08/15/ 2023 and 08/28/2023 requested from S1 medical discharge, medical records, hospice records, and facility log notes relating to higher level of care (e.g., stage 1, 2, 3, and 4 confirmations of higher level of care).

Allegation: Staff did not observe resident had open wound

It’s being alleged the facility has not observed “Staff did not observe resident had open wound.” 6 out of 6 residents interviewed goes as follows: Residents 1, 2, 3, 5, 6, 7 (R1-R3 and R5-R7) all have dementia and verbal (Classified: As verbal by S1. LPA could not interview R1-R3 and R5-R7 all have dementia and are classified as "Alert and oriented x1 to name" as referenced by the appraisal/needs and services plan LPA reviewed R2).

4 out of 4 staff denied the allegation, S1-4 denied observing “Staff did not observe resident had open wound.”

1 out of 1 Witness 1 (W1) agreed with the allegation ““Staff did not observe resident had open wound.”

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230810130243

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD HANDS HOMECARE	FACILITY NUMBER: 198320041
	VISIT DATE: 09/13/2023

NARRATIVE

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Allegation: Staff did not disclose to POA resident's health condition. Regarding the allegation: “Staff did not disclose to POA resident's health condition.” Based on LPA’s observations, interviews with S 1-4 and record reviews, and W1 interviews goes as follows: S1-4 that that facility resident family members/responsible party were notified of all changes relating to resident’s health condition. S1, informed the LPA that all changes of resident’s health were discussed with POA and documented in their case file. S1 also stated that S2-4 makes sure that family members are notified and also arrange for medical appointments.

In addition, S1 and S2 inform family of resident incidents that occur in the facility in person, however, not in written form. According to S1 and S2 there has never been an issue with a resident’s family member not being notified of changes to a resident’s condition. According to S1 and S2 the POA was spoke to weekly or biweekly regarding changes of resident’s conditions. Due to R1 terminal illness, W1 provided documentation to the LPA about the assessment process for R1 (placement ending date: 06/12/2022). LPA confirmed that between June 12, 2021, and April 20, 2022, according to W1, that R1 obtained care from Good Hands Homecare. In addition, on May 22, 2022, per W1, R1 was taken to the Torrance Memorial Hospital to treat her injuries.

W1 noted that R1 had been taken to Dignity Hospice. W1 stated R1 was in COVID isolation at the Downey Community Health Center. On June 16, 2022, R1 was transferred to the Sunny Day Guest Home, where medical professionals and caregiver detected lesions in the second stage of their development. R1 passed away on August 21, 2022.

6 out of 6 residents interviewed goes as follows: Residents 1, 2, 3, 5, 6, 7 (R1-R3 and R5-R7) all have dementia. LPA could not interview R1-R3 and R5-R7 all have dementia.

4 out of 4 staff denied the allegation, S1-4 denied observing “Staff did not disclose to POA resident's health condition.”

1 out of 1 Witness 1 (W1) agreed with the allegation “Staff did not disclose to POA resident's health condition.”

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20230810130243

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GOOD HANDS HOMECARE	FACILITY NUMBER: 198320041
	VISIT DATE: 09/13/2023

NARRATIVE

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Based on interviews conducted, record reviews and observation, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

A copy of this report was provided and discussed and left with Licensee Administrator Michelle Porca whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: David Espana
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2023

LIC9099 (FAS) - (06/04)

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