198602202-7-3-2021-11-AS-AJKK-C5EUD4-20210730152855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602202
Report Date: 06/30/2021
Date Signed: 07/03/2021 03:10:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2021 and conducted by Evaluator Lourdes Montoya

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210506114006

FACILITY NAME:	MERIDIAN HOME CARE		FACILITY NUMBER:	198602202
ADMINISTRATOR:	SAN AGUSTIN, JENNIFER G		FACILITY TYPE:	740
ADDRESS:	20526 WOOD AVENUE		TELEPHONE:	(310) 533-7898
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 6	DATE:	06/30/2021
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Joseph Sol		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility did not comply with public health order.
Staff yelled at residents.
Residents not accorded dignity in their relationships with staff.

INVESTIGATION FINDINGS:

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On 6/30/2021, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced case management visit to deliver complaint findings. LPA Montoya called the facility and spoke with Licensee Joseph Sol. At around 8:44 am, LPA conducted a risk assessment over the telephone. Based on the assessment, the facility is clear of Covid-19 infection. At around 9:30 am, LPA Montoya met with Joseph Sol, and LPA explained the purpose of the visit.

Investigation consisted of the following: A tour of the facility, interviews with the licensee, staff, and residents on 5/12/2021; telephone interview of witnesses, review of each resident’s admission agreement, physician’s report and Appraisal/Needs and Services Plan, visitors log dated 12/2/2020-5/12/2021, screening log, staff roster, resident roster, personnel reports (LIC 500), staff training on infection prevention and control, and staff training on personal rights.

REPORT CONTINUED IN LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

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-20210506114006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: MERIDIAN HOME CARE	FACILITY NUMBER: 198602202
	VISIT DATE: 06/30/2021

NARRATIVE

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The investigation revealed the following:

Allegation: Facility did not comply with the public health order.

It is alleged the facility did not comply with the public health order. Based on LPA's records review, the licensee has conducted a series of training on Covid-19 Preparedness and Response Plan to facility staff on November 11, 13, 18, and 20, 2020. LPA conducted interviews with the Licensee (Staff #1), Administrator (Staff #2), House Manager (Staff #3), Caregiver (Staff #4), three (3) out of six(6) Residents (#1-#3), and two (2) neighbors, (Witnesses #1-#2). Based on record review, Daily Covid-19 Screening Log shows that all residents are screened for Covid-19 symptoms, and temperature is checked. Visitors log dated 12/2/2021-5/12/2021 show visitation is allowed but with a limited number of guests to maintain physical distancing. Staff are screened daily for Covid-19 symptoms, and temperature is also checked. Based on interviews with Staff #1-#4, visitation is allowed, but a limited number of guests enter the resident’s bedroom; some guests stay in the backyard, or they stand behind the sliding door of the resident’s bedroom. Every visitor is screened for Covid-19 symptoms, and temperature is checked at the main entrance. Each resident’s visitor must wear a mask upon entry; if the visitor does not have a mask, staff will provide one. Interviews with Residents #1-#3 revealed that all visitors are screened for Covid-19 symptoms, the temperature is checked, and each guest wears a mask upon entry at the facility. Residents #1-#3 stated they don’t usually observe the number of guests entering the facility simultaneously, but they know that number of guests allowed to enter the facility is limited to maintain physical distancing. LPA was unable to obtain information from Residents #4-#6 due to their dementia diagnosis. Witness #1-#2 stated they observed guests in the backyard and side yards; no other concerns were provided regarding the Covid-19 related public health order. LPA Montoya attempted to contact two (2) Responsible Persons (Potential Witnesses #3-#4) but unable to reach them. Based on LPA’s observations, interviews, and record reviews, LPA did not find sufficient evidence to support the allegation mentioned above.

Allegation: Staff yelled at residents.

It is alleged the facility staff yelled at residents. Based on LPA's records review, the licensee has conducted a series of training on Direct Care Staff Orientation and Residents' Personal Rights on January 8, 10, 27, and 28, 2020, February 12 and 13, 2020. LPA conducted interviews with the Licensee (Staff #1), Administrator

REPORT CONTINUED IN LIC 9099-C

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210506114006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: MERIDIAN HOME CARE	FACILITY NUMBER: 198602202
	VISIT DATE: 06/30/2021

NARRATIVE

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(Staff #2), House Manager (Staff #3), Caregiver (Staff #4), three (3) out of six(6) Residents (#1-#3), and two (2) neighbors, (Witnesses #1-#2). Based on interviews with Staff #1-#4 and Residents #1-#3, no staff has ever yelled at any resident or mocked any resident. LPA was unable to obtain information from Residents #4-#6 due to their dementia diagnosis. Interviews with Witnesses #1-#2 indicate that they could hear staff yell at residents, but they cannot provide any evidence. LPA Montoya attempted to contact two (2) Responsible Persons (Potential Witnesses #3-#4) but unable to reach them. Based on LPA’s observations, interviews, and record reviews, LPA did not find sufficient evidence to support the allegation mentioned above.

Allegation: Residents are not accorded dignity in their relationships with staff.

It is alleged the facility residents are not accorded dignity in their relationships with staff. Based on LPA's records review, the licensee has conducted a series of training on Direct Care Staff Orientation and Resident's Personal Rights on January 8, 10, 27, and 28, 2020, February 12 and 13, 2020. LPA conducted interviews with the Licensee (Staff #1), Administrator (Staff #2), House Manager (Staff #3), Caregiver (Staff #4), three (3) out of six(6) Residents (#1-#3), and two (2) neighbors, (Witnesses #1-#2). Based on interviews with Staff #1-#4, they treat all residents well like their own family. Interview with Residents #1-#3 revealed staff treat them well. LPA was unable to obtain information from Residents #4-#6 due to their dementia diagnosis. Interview with witnesses #1-#2 revealed they could hear a resident yelling out for help continuously for an hour every morning while staff continuously yell back and ignore the resident’s plea for help. Both witnesses stated they could not provide any proof to support this allegation. LPA Montoya attempted to contact two (2) Responsible Persons (Potential Witnesses #3-#4), but unable to reach them. Based on LPA’s observations, interviews, and record reviews, LPA did not find sufficient evidence to support the allegation mentioned above.

Based on information gathered, LPA did not find sufficient evidence to support the allegations, “Facility did not comply with public health order,” “Staff yelled at residents,” and “Residents not accorded dignity in their relationships with staff.”.

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 allegations are UNSUBSTANTIATED.

No deficiencies were cited. An exit interview was conducted. A hard copy of the report was provided to Licensee Joseph Sol.

SUPERVISORS NAME: Angela J Kendrick
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2021

LIC9099 (FAS) - (06/04)

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