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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320199
Report Date: 06/13/2024
Date Signed: 06/13/2024 12:30:52 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
06/27/2023 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230627141017
FACILITY NAME:KEEN HOME LONG BEACHFACILITY NUMBER:
198320199
ADMINISTRATOR:ADRIEN HERBASFACILITY TYPE:
740
ADDRESS:6441 BIXBY HILL RDTELEPHONE:
(562) 438-5336
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:6CENSUS: 5DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
08:04 AM
MET WITH:LaToya Johnson, AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not provide proper food service to resident in care
Staff did not follow proper refund requirements
Staff threatened to destroy resident's medication
Staff overcharged resident/resident's representative
INVESTIGATION FINDINGS:
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On 06/13/2024 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent complaint visit to deliver findings for the above-mentioned allegations. LPA was met by LaToya Johnson, Administrator (S2) and the purpose of the visit was explained.

The investigation consisted of the following:
On 06/13/2024 LPA arrived to deliver findings for the above-mentioned allegations. On 05/24/2024 LPA requested feeding schedule and information regarding special diet(s) for residents present during that period. On 04/09/2024 LPA interviewed 4 residents. On 03/18/2024 LPA requested training records for all staff who were present during resident one's (R1) stay and a copy of R1’s hospice care plan. LPA also interviewed two (2) staff. On 06/28/2023 LPA conducted an unannounced complaint visit to the above-mentioned facility. LPA was met by Aurora Ortiz, Team Lead (S3), and later by Adrien Herbas, Administrator (S1), and the purpose of the visit was explained.
Report continues, see LIC9099C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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-20230627141017
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: KEEN HOME LONG BEACH
FACILITY NUMBER: 198320199
VISIT DATE: 06/13/2024
NARRATIVE
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 LPA requested resident roster, staff roster, hospice care plans, physician reports, pre-placement appraisals, appraisals, identification and emergency contacts and other service documents which related to rental fees and back pay. A plant inspection was conducted and above-mentioned records were reviewed.
The investigation revealed the following:
Regarding the allegation “Staff did not provide proper food service to resident in care”, It has been alleged that staff were uninformed regarding the feeding procedures for R1 during the weekend of 05/26/2023 through 05/29/2023. Record reviews revealed that on 05/27/2023 R1’s hospice team ordered “NPO” (Nothing By Mouth), which is shorthand for a period of time in which one may not eat or drink anything, aside from comfort medication. Interviews held on 06/28/2023 and 03/18/2024 revealed that four (4) out of 4 staff and three (3) out of four (4) residents have denied the allegation had taken place, while one (1) resident was unable to provide a verbal or visual response. Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Staff did not follow proper refund requirements”, it has been alleged that staff did not provide any refund(s) for the dates as follows: 06/02/2023 through 06/05/2023. Record reviews revealed that the balance of $11,916.68 was paid to a family member of R1, posted on 06/12/2023. Record reviews also indicated that "unused rent moneys will be returned 15 days after room is vacated of all belongings, clothing and furnishings." and that R1's hospice items were removed from the facility on 06/04/2023. Interviews held on 06/28/2023, 03/18/2024 and 04/09/2024 revealed that 4 out of 4 staff and three (3) out of four (4) residents have denied the allegation had taken place, while one (1) resident was unable to provide a verbal or visual response.
Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.





Report continues, see LIC9099C.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230627141017
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: KEEN HOME LONG BEACH
FACILITY NUMBER: 198320199
VISIT DATE: 06/13/2024
NARRATIVE
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Regarding the allegation “Staff threatened to destroy resident's medication”, it has been alleged that staff were uninformed regarding the delivery of comfort medications to R1, while R1 was under the above-mentioned facility’s care. Record reviews revealed that during a visit on 05/30/2023, by a skilled nurse (SN), visit notes were logged as follows: “SN reinforced teachings with caregiver, S3, on pain management including use of morphine and ativan as needed. Caregiver, S3, verbalized understanding and able to repeat back information.”. Interviews held on 06/28/2023, 03/18/2024 and 04/09/2024 revealed that 4 out of 4 staff and three (3) out of four (4) residents have denied the allegation had taken place, while one (1) resident was unable to provide a verbal or visual response. Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Staff overcharged resident/resident's representative”, it has been alleged that staff had charged for fees related to an Emergency Department visit with R1 on 02/24/2023, when S1 had verified with the family member of R1 that monthly fees were to cover “transportation to all medical appointments.” and “Transportation and accompaniment are offered for all medical appointments. If you or another family member aren't present for an appointment, then our staff will take responsibility for communicating with the medical professionals and confirming new orders. You will receive a follow-up report after the appointment. If you or another family member are present, then our staff will wait for your resident while you're in the appointment together.” S2 later stated that “Family members and/or Legal representatives are responsible to transport and accompany their loved ones to all appointments or emergency medical visits. Otherwise, we must have an additional staff member manage the appointments/emergencies. Therefore, there is an additional charge. The charge is at our cost to afford the employee’s time/pay that we incur. There is no mark-up.”
Record reviews revealed that the refund was provided to R1's family member on 04/01/2023, and was paid on 04/02/2023, in the balance of $357.50. Interviews held on 06/28/2023, 03/18/2024 and 04/09/2024 revealed that 4 out of 4 staff and three (3) out of four (4) residents have denied the allegation had taken place, while one (1) resident was unable to provide a verbal or visual response.
Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Report continues, see LIC9099C
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230627141017
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: KEEN HOME LONG BEACH
FACILITY NUMBER: 198320199
VISIT DATE: 06/13/2024
NARRATIVE
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Therefore, the above allegation has been Unsubstantiated.

There have been no deficiencies cited today.

An exit interview was held with LaToya Johnson, Administrator (S2), and a copy of this report has been provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4