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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320046
Report Date: 05/11/2023
Date Signed: 05/11/2023 01:41:26 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
02/03/2022 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220203121216
FACILITY NAME:DROCK HOME CAREFACILITY NUMBER:
198320046
ADMINISTRATOR:ADAMSON RUKAYATFACILITY TYPE:
740
ADDRESS:1652 E CYRENE DRIVETELEPHONE:
(310) 997-8046
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:6CENSUS: 6DATE:
05/11/2023
UNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Rukakyat AdamsonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Resident is being retaliated against.
Resident is not being provided activities.
Resident is being financially abused while in care.
INVESTIGATION FINDINGS:
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On 05/11/2023, Licensing Program Analyst (LPA) Perry Scott conducted a continuation of a complaint visit that was done on 02/03/2022. LPA Scott met with Licensee, Rukayat Adamson, and explained the purpose of this visit is to deliver findings from a previous complaint.

On 2/3/2022, Licensing Program Analyst (LPA) Martessa Brown conducted a complaint investigation regarding the above listed allegations. LPA met with staff Funmilola Lawal-DSP and was later met by Adamson Rukakyat, the facility Administrator and the purpose of today's visit was explained.

On 02/03/2022, the investigation consisted of the following:

During today’s visits LPA toured the entire facility. LPA reviewed Clients #1-2 Admissions Agreement, Physicians Reports. medication cabinet/medication records and Residents Roster. LPA requested the following documents: Lic 500 Residents Appraisals, Needs & Services, and activity calendar by 2/7/2022. LPA interviewed Resident R#1, R#2,R#3 & R#4. LPA attempted to interviews R#5.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
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 3
Control Number 11-AS-20220203121216
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: DROCK HOME CARE
FACILITY NUMBER: 198320046
VISIT DATE: 05/11/2023
NARRATIVE
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The investigation revealed the following: Regarding allegation #1: Resident is being retaliated against.

On 05/10/23 at 10:00am, LPA interviewed S1. S1 denied the allegation that the Resident is being retaliated against. S1 stated that at no point in time has anyone, me or my staff has ever retaliated against a resident for filing a complaint; or because someone filed on their behalf. It is my practice to sit down with my residents and try to resolve any conflict that arises in the facility. Moreover, I try to resolve any conflict with the representatives of the residents.

On 05/10/23, LPA interviewed S2 about the allegation that the Resident is being retaliated against. S2 denied the allegation and asserted that they are not retaliating against any resident. S2 stated that they try and treat each resident with respect no matter the conflict.

On 05/10/23, LPA interviewed R1-R6 about the allegation that Resident is being retaliated against. Residents R1-R2 denied the allegation and confirmed that they are receiving proper treatment and have no issues with the staff. And have not been retaliated against for any complaint made by them or their representative. R3-R6 was not able to be interviewed due to cognitive impairment issues. LPA observed the residents in care and noticed that they all seemed to be happy with no discernable issues.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation: Resident is being retaliated against. 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.

Regarding allegation #2: Resident is not being provided activities.

On 05/10/23 at 10:00am, LPA interviewed S1. S1 denied the allegation that Resident is not being provided activities. S1 stated that we provide a variety of activities for the residents. I try to take them on weekly car rides to the park to get them out of the facility. Additionally, we provide exercise activities to keep them healthy. We have puzzles, games, and I try to keep them active by having them walk around the facility with me to keep their strength up. Additionally, all of the residents that can participate, they do. However, those that don’t want to participate I don’t force them to do anything they don’t want to do. LPA observed a calendar of activities posted in the facility.

On 05/10/23, LPA interviewed S2 about the allegation that the Resident is not being provided activities. S2 denied the allegation and stated that the facility provides a number of different activities for the residents. For instance, we play card games, there are puzzles, also we take them on car rides to the park.

On 05/10/23, LPA interviewed R1-R6 about the allegation that the Resident is not being provided activities. Residents R1-R2 denied the allegation and confirmed that the facility does provide activities for the resident. R1 stated that R1 does not participate because R1 is bedridden. R3-R6 was not able to be interviewed due to cognitive impairment issues.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation: Resident is not being provided activities. 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.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20220203121216
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: DROCK HOME CARE
FACILITY NUMBER: 198320046
VISIT DATE: 05/11/2023
NARRATIVE
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Regarding allegation #3: Resident is being financially abused while in care.

On 05/10/23 at 10:00am, LPA interviewed S1. S1 denied the allegation that the Resident is being financially abused while in care. S1 stated that one of the representatives for a resident believes that I am financially abusing a resident because I stated that I was going to be increasing the basic rate services. I have a right to do that it is in the admission agreement, and I also issued a 60-day notice of the increase. Additionally, the representative said I was financially abusing the resident because I was not providing incontinence items. Per the admission agreement, the family is required to do that. However, I keep a personal supply for times when the family is short. I supply it to the resident only until they can supply their own. Plus, the resident complains about the diapers the representative brings and prefers mine because mine is of a higher quality. I am not nor have I ever financially abused a resident while in care.

On 05/10/23, LPA interviewed S2 about the allegation that the Resident is being financially abused while in care. S2 denied the allegation and stated that none of the residents have complained of being financially abused. And to my knowledge they are not.

On 05/10/23, LPA interviewed R1-R6 about the allegation that the Resident is being financially abused while in care. Residents R1-R2 denied the allegation and confirmed that the facility is not financially abusing them. R3-R6 was not able to be interviewed due to cognitive impairment issues.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation: Resident is being financially abused while in care. 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.

No deficiencies were cited.

An exit interview has been conducted and a copy of the Complaint Report provided to Licensee, Rukayat Adamson.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3