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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320353
Report Date: 08/09/2023
Date Signed: 01/31/2024 09:55:22 AM

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
07/31/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20230731131913
FACILITY NAME:HARVARD HOPE HOUSEFACILITY NUMBER:
198320353
ADMINISTRATOR:COXSOM, AMBERFACILITY TYPE:
740
ADDRESS:4239 S. HARVARD BLVDTELEPHONE:
(323) 812-0788
CITY:LOS ANGELESSTATE: CAZIP CODE:
90062
CAPACITY:6CENSUS: 4DATE:
08/09/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:ADMINISTRATOR AMBER COXSOMTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not providing adequate supervision to residents in care.
Staff are intoxicated while caring and supervising residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT SUPERSEDES THE REPORT DATED 08/09/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Harvard Hope House on 08/09/2023 and was greeted by Administrator Amber Coxsom (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
During this investigation, LPA Calderon interviewed A1, S1, R1-R4, W1-W3. This interview was conducted on 08/09/2023. On 08/09/2023 LPA Calderon requested copies of the following: Video of facility home for 7/28, 7/29.
The investigation revealed the following:

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
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-20230731131913
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: HARVARD HOPE HOUSE
FACILITY NUMBER: 198320353
VISIT DATE: 08/09/2023
NARRATIVE
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9
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Regarding Allegation #1: Staff are not providing adequate supervision to resident in care.

This complaint alleged staff are not supervising residents in care. On 08/09/2023 LPA Calderon interviewed A1 for a complaint. A1 claimed that A1 was out of town on 07/28 and 7/29/2023. A1 admitted that vehicles do intersection takeovers and claimed by the complainant, but that no one associated with the facility had anything to do with the illegal actions. A1 lives in the back house and can supervise the licensed facility from close quarters.


According to A1, S1 worked the night shift, and no one entered the facility after hours.
On 08/09/2023 LPA Calderon interviewed S1 for this complaint and verified that S1 worked a double shift, no one entered the facility during or after hours and that the residents’ needs were met with S1's care and supervision.
On 08/09/2023 LPA Calderon interviewed W1-W3 for complaint. W1-W2 reported they witnessed people coming from the back of the house and were drinking and doing drugs. W1-W2 claimed that unknown people were doing donuts in the middle of the intersection around 3 am on 07/29/2023 and they have video, of a female intoxicated and yelling in front of the facility. W3, a family member of A1, claimed that W3 did stay at A1's home and not at the licensed facility on 07/29/2023 and that W3's friend had taken W3’s car and made donuts in the middle of the intersection at 3 am. W3 recalled that no one had ever been into the facility but W3 did verify that W3 and a friend had been drinking. On 08/09/2023 LPA Calderon interviewed R1-R4 for this complaint. R2-R3 reported that they love living at the facility, had no immediate concerns about the care and supervision and that their needs are being met. enough staff to take care of their needs. R2-R3 stated that no strangers were observed inside the facility and had no knowledge of outside reckless activities. LPA Calderon was presented with surveillance video by the A1, the video revealed no one entered or exited the facility after hours on 07/29/23. Additionally, a white vehicle was seen driving in the middle of the intersection, but the driver's identity could not be determined.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20230731131913
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: HARVARD HOPE HOUSE
FACILITY NUMBER: 198320353
VISIT DATE: 08/09/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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27
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30
31
32
Regarding Allegation #2: Staff are intoxicated while caring and supervising residents in care.

This complaint alleged staff intoxicated while taking care of residents in care. On 08/09/2023 LPA Calderon interviewed A1 for this complaint. A1 claimed to be out of town on 7/28 and 7/29/2023 when the incident happened. A1 declared that at no time had any staff members ever worked intoxicated while taking care of residents.



A1 recalled that there was an intersection takeover, but this had nothing to do with A1 licensed staff, residents, or facility. On 08/09/2023 LPA Calderon interviewed S1 for this complaint and denied this accusation. S2-S3 reported that no staff member has ever worked intoxicated while caring for residents including S1. S2-S3 claimed that no staff has ever been drunk while taking care of their needs. R2-R3 stated that they love living at the facility. On 08/09/2023 LPA Calderon interviewed W1-W3 for complaint. W1-W2 stated that they observed people intoxicated coming from the back of the A1 home. W1-W2 stated that A1 family members were seen in front of the facility intoxicated. W3, a family member of A1, admitted that W3 and friends had some drinks at a local bar on 7/29 around 3:00 am. According to W3, W3 nor any friends ever entered the licensed facility and were not intoxicated. LPA Calderon reviewed the surveillance video, and it revealed unwarranted activity capture on footage.

Therefore, evidence gathered from investigation there is insufficient evidence to prove that “staff are not providing adequate supervision to resident in care” “staff are intoxicated while caring and supervising residents in care”, therefore the allegation is unsubstantiated.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Amber Coxsom (A1).

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3