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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320095
Report Date: 03/08/2025
Date Signed: 03/08/2025 12:35:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/14/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240314140250
FACILITY NAME:HAWTHORNE TERRACE CARE HOME, LLCFACILITY NUMBER:
198320095
ADMINISTRATOR:HAUF, MARYFACILITY TYPE:
740
ADDRESS:4760 W 123RD STTELEPHONE:
(201) 562-8622
CITY:HAWTHORNESTATE: CAZIP CODE:
90250
CAPACITY:14CENSUS: 9DATE:
03/08/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Mary HaufTIME COMPLETED:
10:57 AM
ALLEGATION(S):
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Staff behavior is preventing a resident from sleeping.
Staff do not prevent the residents from arguing.
Staff did not prevent a resident from falling out of bed.
Staff is retaliating against a resident.
INVESTIGATION FINDINGS:
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***This amended report supersedes the report dated 03/21/24. This report is created to serve as an amendment to clarify findings. ***

On March 8, 2025, the California Department of Social Services/Community Care Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent, unannounced complaint visit. The Administrator Josephine Hauf greeted the (LPA). The (LPA) explained that the purpose of this visit was to investigate the allegations mentioned above.

The investigation included interviews, collection of records and tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3), and resident members #1 to -#5 (R1-R5). The Department reviewed several documents, including the Facility Staff Roster, the Resident Roster, Unusual Incident Reports, Staff Hands-On Training, Personal Rights, Centrally Stored Medication,
(Evaluation Report continues LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
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 5
Control Number 11-AS-20240314140250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
VISIT DATE: 03/08/2025
NARRATIVE
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Identification and Emergency Information, Physician Report, Resident Appraisal, Admission Agreement, Daily Notes/Staff Notes/ Facility Notes (dated 02/21/24 through 03/20/24), and other pertinent records associated with this complaint.

INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff behavior is preventing a resident from sleeping.

The complaint alleges that facility staff are preventing Resident #1 (R1) from sleeping. It is reported that both staff and residents are disrupting (R1) due to ongoing arguments. No additional details were provided regarding this matter.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to support this claim. Three (3) out of the (3) staff members revealed confirmation that there were no concerns related to staff behavior or any reported incidents that interfered with residents' ability to sleep. (S1-S3) reported that no behaviors were observed, which resulted in (R1) being unable to sleep.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) residents indicated that they did not experience any behavior issues caused by staff or other residents that interfered with their sleep. Resident #1 (R1) stated everything was fine and confirmed no interruptions from either staff or residents affecting (R1's) ability to sleep. In contrast, Resident #2 and Resident #4 expressed concerns; they mentioned that a staff member and a resident were disruptive; however, they found it challenging to identify specific dates that would support their claims about the disturbances.

The Department reviewed staff training records and resident personal rights, revealing that the staff have completed training related to Redirecting, De-escalating Conflicts, Personal Care Techniques, Physical Needs of Elderly, and Psychosocial Needs of the Elderly.

Based on the information gathered, there is not enough evidence to support the allegations mentioned above.

(Evaluation Report continues LIC9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240314140250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
VISIT DATE: 03/08/2025
NARRATIVE
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Allegation #2: Staff do not prevent the residents from arguing.

The details of the complaint alleged staff are unable to prevent residents from arguing. According to the report staff do not prevent the residents from having arguments. No additional details were provided regarding this matter.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to corroborate this claim. Three (3) out of the (3) staff members reported taking proactive measures to de-escalate tense situations among residents, preventing disputes from escalating. (S1) added the facility is equipped with a surveillance camera designed to monitor and record all activities, ensuring a level of security and accountability. (S1) mentioned one resident had a disagreement with the staff, not with other residents, which was resolved.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) residents to have issues with any staff members. (R1) observed staff and residents disagreeing at times. However, the staff managed these disputes quickly, resolving conflicts quietly. This approach maintained a pleasant situation and made both staff and residents feel heard and acknowledged. Resident #2 (R2) admitted a genuine confusion about the distinctions that separate arguing, debating, and discussing, highlighting a critical opportunity for deeper engagement, and understanding.

The Department reviewed staff training records and resident personal rights, revealing that the staff have completed training related to Resident Rights, Resident Behavior Changes, Cultural Competency, and Sensitivity Issues. The Department observed surveillance cameras in common areas during the inspection. These cameras record activities for security and safety purposes.

Allegation #3: Staff do not prevent a resident from falling out of bed.

The complaint alleges that the staff failed to prevent Resident #1 (R1) from falling out of bed. It was reported that R1 fell from the bed a week ago due to its placement within the room. Additionally, it has been noted that the room's configuration makes the door too narrow for R1 to pass through, requiring R1 to crawl into the room.

(Evaluation Report continues LIC9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240314140250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
VISIT DATE: 03/08/2025
NARRATIVE
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On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who is not able to validate this claim. Three (3) out of the (3) staff members expressed the facility takes precautions to prevent falls with residents in care. According to (S1), the facility is fully equipped with effective fall prevention devices for all residents, including bed rails, floor mats, and call alarms. (S2-S3) reported to ensure resident safety, bed rails are used, beds are kept at the lowest level, and fall mats are placed beside the beds. Residents at higher risk are monitored more closely. (S1) reported a resident tried to get out of bed independently, despite being told to call for help. This triggered the call alarm, but staff quickly assisted.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Four (4) out of the five (5) have avoided falls and have not witnessed any incidents with other residents in care. (R1) stated to have not experienced a fall or witnessed one; only heard about it. (R1) indicated is able access the room easily, without using a wheelchair, and encountered no difficulties with the door. (R2) noted that falls occurred with one resident but lacked detailed information.

The Department examination of the records, encompassing daily observations, staff documentation, and facility logs spanning from February 21, 2024, to March 20, 2024. This review uncovered that there had been no incidents of falls among any residents during this period, reflecting the effective safety measures in place and the care provided by the staff. An analysis of the completed staff training included Postural Support, Safe Use of Medical Equipment, and Techniques for Personal Care Services. During the inspection visit, the Department noted that half-bed rails were used for all residents in care.

Based on the information gathered, there is not enough evidence to support the allegations mentioned above.

Allegation #4: Staff is retaliating against a resident.

The complaint details alleged that the staff retaliated against Resident #1 (R1). It is reported Staff #1 (S1) has shown increasingly harsh behavior towards (R1) since (R1’s) last report. It is also noted that (R1) is being restricted from smoking. No additional details were provided regarding this matter.

(Evaluation Report continues LIC9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240314140250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: HAWTHORNE TERRACE CARE HOME, LLC
FACILITY NUMBER: 198320095
VISIT DATE: 03/08/2025
NARRATIVE
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On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed staff members identified as Staff #1, Staff #2, and Staff #3 (S1-S3) who disputed this accusation. Three (3) out of the (3) staff members uttered we genuinely value and appreciate every resident, regardless of how they may respond to the staff. We understand that some might perceive rule enforcement or care procedures as punitive, but these measures are vital for ensuring their health and safety. We strive to maintain transparency by documenting all interactions, which promotes clarity and fairness. What might feel like retribution is our commitment to upholding rules that safeguard everyone. As (S1) stressed, we diligently follow each resident's care plan and deliver essential services. Any feelings of being disciplined often stem from misconceptions about our dedicated care and the consistent application of rules meant for everyone's benefit. S1-S3 expressed residents are permitted to smoke outside the facility without restrictions.

On March 21, 2024, between 8:54 AM and 5:00 PM, the Department interviewed resident members identified as Resident #1 to Resident #5 (R1-R5). Three (3) out of the five (5) asserted that they have never encountered any behavior of that nature from the staff and cannot support the claim. (R1-R2) reported that staff members limited communication between residents for safety and privacy reasons. However, they did not provide specific details or reasons for these restrictions. Four (4) out of five (5) claimed their facility did not have smoking restrictions and that smoking was allowed outside the facility. (R1) confirmed that the facility operated without restrictions, ensuring accessibility and flexibility.

The Department reviewed the records, including daily observations, staff documentation, and facility logs, from February 21, 2024, to March 20, 2024. This review found no evidence of behaviors intended to harm or punish individuals for their actions. Moreover, an analysis of the hands-on training conducted by staff included De-Escalation Techniques, Resident Rights, and Personal Care Procedures.

Based on the information gathered, there is not enough evidence to support the allegations mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are deemed Unsubstantiated.

An exit interview was conducted with Mary Hauf, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5