198602216-9-27-2023-11-AS-UCOL-CYQR4M-20231221114145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602216
Report Date: 09/27/2023
Date Signed: 09/27/2023 04:42:57 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
09/25/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230925092109

FACILITY NAME:	FRANCESCA'S HOME		FACILITY NUMBER:	198602216
ADMINISTRATOR:	COELLO, BESSIE L		FACILITY TYPE:	740
ADDRESS:	20520 AVIS AVENUE		TELEPHONE:	(310) 292-8425
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90503
CAPACITY:	6	CENSUS: 6	DATE:	09/27/2023
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Bessie Coello, Administrator		TIME COMPLETED:	05:06 PM

ALLEGATION(S):

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Staff are not providing services according to resident's plan.
Staff did not provide resident copies of signed admission paperwork.

INVESTIGATION FINDINGS:

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On 09/27/23 Licensing Program Analyst (LPA) Mario Leon conducted an unanounced complaint visit to the above mentioned facility to investigate on the above allegations. LPA was met by Bessie Coello, Administrator (S1), and the purpose of the visit was explained.

The Investigation consisted of the following:
On 08/30/23 LPA Leon toured the facility with Administrator, interviewed five (3) staff (S1-3), the reporting party (RP), two (2) witnesses (W1-2) and two (2) residents (R1-2). LPA Leon requested and reviewed facility documents.

The investigation revealed the following:
LPA reveiwed facility documents and interviewed S1. Regarding the allegation: Staff are not providing services according to resident's plan.
Report continues, see LIC9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

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-20230925092109

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: FRANCESCA'S HOME	FACILITY NUMBER: 198602216
	VISIT DATE: 09/27/2023

NARRATIVE

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It has been alleged that staff did not ensure that resident was provided a hospital bed and staff did not ensure that resident received physical therapy services.
Through record review, there was no physician's report notifying that R1 was to require a hospital bed (HB) after R1's discharge from rehabilitation center. HB has been denied by the Case Manager with R1's insurance company. Furthermore, Physical Therapy (PT) had not been notified that R1 had been discharged to this care facility and had placed R1's file on hold. Through LPA observation, Administrator had verified with the home health agency's (HHS) Supervisor that R1's treatment will be resumed. Upon HHS resuming R1's treatment, the Physical Therapist will re-evaluate for the need of a HB for R1.

According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstatiated.

Regarding the allegation: Staff did not provide resident copies of signed admission paperwork. It has been alleged that the request for the admissions agreement was not provided on the date of admission of R1.
Through record review, the admissions agreement has a line written, and initialed by the responsible person of R1, as follows, "I have received a copy of this Admission Agreement __________ initial". Through interviews, both parties have opposing positions. S1 will provide additional copies of the admissions agreement of R1, through email, to the responsible person(s) of R1 on 09/27/23.

According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstatiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2023

LIC9099 (FAS) - (06/04)

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