198602191-1-23-2025-11-AS-JHAD-DDFRAG-20250131115108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602191
Report Date: 01/22/2025
Date Signed: 01/23/2025 07:50:41 AM

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
01/14/2025 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250114112502

FACILITY NAME:	CASA DEL SOL II RESIDENCE		FACILITY NUMBER:	198602191
ADMINISTRATOR:	YCHEAL D. LEVINE		FACILITY TYPE:	740
ADDRESS:	11600 W WASHINGTON BLVD		TELEPHONE:	(310) 390-9045
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90066
CAPACITY:	6	CENSUS: 1	DATE:	01/22/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Vida Zedaya		TIME COMPLETED:	04:07 PM

ALLEGATION(S):

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Staff made inappropriate comments towards resident.
Staff are not treating resident with respect.

INVESTIGATION FINDINGS:

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On January 22,2025, an associate from the California Department of Social Services/Community Care Licensing (CDSS/CCL) conducted an initial unannounced complaint visit. The Medicaton Nurse, Vida Zelaya, greeted the associate. The associate explained that the purpose of this visit was to investigate the allegations mentioned above.

The investigation included a tour of the facility, interviews, and the collection of records. Interviews were conducted with staff members #1, #2 (S1-S2) and residents members #2 through #5 (R2-R5). The associate reviewed several documents, including the Personnel Schedule Sheet (dated 01/01/25), the Facility Roster (dated 0916/24), and Resident #1 (R1's) service records and other records associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

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 3

Control Number 11-AS-20250114112502

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: CASA DEL SOL II RESIDENCE	FACILITY NUMBER: 198602191
	VISIT DATE: 01/22/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff made inappropriate comments towards resident.

Allegation #2: Staff are not treating resident with respect.

The complaint stated that the facility staff made inappropriate comments towards Resident #1 (R1) and did not treat (R1) with respect. It specifically noted that Staff #1 and Staff #2 (S1-S2) made unkind and rude remarks and failed to show respect towards (R1). The complaint mentioned that (R1) was temporarily relocated to this facility due to the Eaton fire disaster and no further details were provided regarding these allegations.

On January 22, 2025, between 10:30 AM and 12:00 PM, the Department interviewed Staff #1 and Staff #2 regarding the allegations that they had made inappropriate comments and treated (R1) disrespectfully. (S1) and (S2) denied making impolite comments or suggesting any mistreatment of (R1).

(S1) explained that (R1) had been relocated to this facility during the Eaton Fire in Pasadena, which occurred from January 9 to January 14, 2025, along with three other residents identified as Resident #2, #3, and #4 (R2-R4).

According to (S1), (R1) is diagnosed with a mental health disorder but is independent and capable of completing all activities of daily living. (R1) only requires supervision and medication management. It was noted on (R1’s) Medication Administration Record that (R1) had refused to take prescribed medication for multiple days upon being transferred to Casa Del Sol II Residence. A single missed of medication can affect mood or behavior, potentially causing feelings of anger, agitation, or depression (reference: National Institute of Health). (S1) reported that (R1) was reluctant to cooperate with the assistance provided by care staff members, and the activities were documented in (R1’s) progress communication notes.

On January 22, 2025, between 10:30 AM and 12:00 PM, the Department interviewed witnesses, identified as Witness # 1 and Witness #2. They could not corroborate the allegations in question. (W1), the facility administrator, and (W2), a med-tech at Pasadena Adult Living Center, confirmed that they faced challenges in providing services to Resident #1 (R1). They noted that the actions of the care staff were often misinterpreted as unruly or discourteous, particularly when dealing with (R1), who only needed redirection.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250114112502

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: CASA DEL SOL II RESIDENCE	FACILITY NUMBER: 198602191
	VISIT DATE: 01/22/2025

NARRATIVE

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(W1) reported that Residents #2, #3, and #4 (R2-R4) had positive feedback about the staff and their experiences at Casa Del Sol II Residence. (W2) added that (R1) frequently refused medications, which often led to (R1) exhibiting derogatory behaviors.

On January 22, 2025, between 11:30 AM and 12:30 PM, the Department interviewed resident members identified as R2, R3, R4, and R5 regarding the allegations. (R2-R5) were unable to validate the accusations. They described their experiences with the staff as positive, respectful, and professional, stating that they had not witnessed any verbal or physical mistreatment that would infringe upon the residents' rights.

An interview with Resident #1 (R1) was not possible as calls went unanswered.

The Department reviewed several documents regarding Resident #1 (R1). These included the physician's report (dated February 1, 2024); the Appraisal/Need and Service Plan (dated January 10, 2025); Facility Progress Notes (dated from January 10 to January 15, 2025); the Nurse's Admission Record (dated January 10, 2025); Identification and Emergency Information (dated April 21, 2022); the Self-Administration of Medication Assessment Record (dated January 10, 2025); and the Medication Administration Record covering (dated December 15, 2024, to January 13, 2025).

The review verified that (R1) is diagnosed with a mental illness, has refused to take medication for (23) consecutive days, and exhibits deprecating behaviors. Based on the gathered information, there is insufficient evidence to support the stated allegations.

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 Veda Zelaya, and copies of the reports were provided.

This report serves as an amendment to clarify the findings. It does not supersede the complaint investigation findings reflected in the report created 01/22/25.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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