198320335-10-18-2023-11-AS-JHAD-CY7NDT-20231204092252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320335
Report Date: 10/18/2023
Date Signed: 10/18/2023 01:02:03 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, 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
10/12/2023 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231012112509

FACILITY NAME:	ATARAXIS HOMES #2		FACILITY NUMBER:	198320335
ADMINISTRATOR:	BUCKMAN, JAMES		FACILITY TYPE:	740
ADDRESS:	6536 SPRINGPARK AVE		TELEPHONE:	(424) 702-5686
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90056
CAPACITY:	6	CENSUS: 5	DATE:	10/18/2023
		UNANNOUNCED	TIME BEGAN:	09:46 AM
MET WITH:	James Buckman		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff confines resident to a wheelchair.
Licensee does not ensure that staff has a criminal clearance.

INVESTIGATION FINDINGS:

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On 10/18/23, at 9:46am, Licensing Program Analyst (LPA) Perry Scott initiated a 10-Day complaint investigation to obtain information regarding the allegations listed above. LPA met with James Buckman and Lori Bucman, Licensees, and explained the purpose of today’s visit.

On 10/18/23, the investigation consisted of the following:

During today’s visit LPA toured the facility. LPA requested the following records: Resident roster, staff roster, resident record (Physicians report, ID/Emergency Information, Staff training in residents Personal Rights & Medication Administration, Assessment and Needs Plan, and Preplacement Appraisal Plan). LPA interviewed staff (S1-S3) and residents (R1-R5).

The investigation revealed the following- Allegation # 1 Staff confines resident to a wheelchair.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231012112509

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATARAXIS HOMES #2	FACILITY NUMBER: 198320335
	VISIT DATE: 10/18/2023

NARRATIVE

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On 10/18/23, from 10:00am-1:00pm, LPA interviewed S1-S3 & R1-R5. It is alleged that staff confines resident R1 to a wheelchair all day and the resident is losing their ability to walk. 3 of 3 staff denied the allegation that Staff confines resident to a wheelchair. All staff stated that R1 is not confined to the wheelchair. R1 can walk around a bit, and they try to keep R1 walking. LPA attempted to interview R1-R5 but was not able to due to cognitive difficulties. LPA observed R1 and did not observe any sign of maltreatment. R1 was in the bed and appeared to be doing well.

Based on interviews, record review, and observations, there is insufficient evidence to support the allegation that Staff confines resident to a wheelchair. 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.

Allegation # 2 Licensee does not ensure that staff has a criminal clearance.

On 10/18/23, from 10:00am-1:00pm, LPA interviewed S1-S3 & R1-R5. It is alleged that the facility has undocumented staff working without a criminal clearance and distributing medication to the residents. 3 of 3 staff denied the allegation that the Licensee does not ensure that staff has a criminal clearance. All staff stated they have had a criminal background and has been cleared. S1 provided LPA with supporting documentation of criminal clearances for all staff and ongoing in-service training for medication, Personal Rights of residents, Dementia Care, and other related training to provide effective care to the residents. LPA attempted to interview R1-R5 but was not able to due to cognitive difficulties. LPA observed that all residents looked well and happy.

Based on interviews, and a record review of staff files, there is insufficient evidence to support the allegation that Licensee does not ensure that staff has a criminal clearance. LPA reviewed all staff records and found that all staff has criminal clearances and the appropriate in-service training to work. 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 was conducted, and a copy of this report was given to James Buckman, Licensee.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 10/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023

LIC9099 (FAS) - (06/04)

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