306005841-1-31-2025-22-AS-MSTC-DDG5FF-20250131185505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005841
Report Date: 01/31/2025
Date Signed: 01/31/2025 11:00:02 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2021 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210701151949

FACILITY NAME:	LOVING HOME CARE		FACILITY NUMBER:	306005841
ADMINISTRATOR:	LE, TIN		FACILITY TYPE:	740
ADDRESS:	13402 HOOVER ST.		TELEPHONE:	(714) 600-7083
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	6	CENSUS: 6	DATE:	01/31/2025
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Tin Le, Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff neglect resulting in resident developing pressure injuries.

Resident developed a septic infection while in care.

Staff did not properly clean resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the three allegations listed above. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit. Administrator Tin Le was notified via telephone and arrived later to assist with the visit.

The initial complaint investigation visit took place on July 7, 2021. Staff interview conducted by the Department. Additional follow-up visits was conducted on December 19, 2023. During this visit, the administrator, primary caregiver and two additional staff members were interviewed along with four facility residents admitted at the time. Records for resident R1 could not be reviewed at that time as they had allegedly been taken by R1’s responsible party at the time of a hospitalization occurring in June 2021. None of the residents interviewed during the follow-up were admitted to the facility at the time of the allegations.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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 2

Control Number 22-AS-20210701151949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LOVING HOME CARE	FACILITY NUMBER: 306005841
	VISIT DATE: 01/31/2025

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
26
27
28
29
30
31
32

CONTINUED FROM FORM LIC9099
An additional follow-up visit took place on January 22, 2025. Administrator Tin Le was interviewed at that time and confirmed that records were not available for review. Additional witness interviews were attempted via email and telephone. R1’s responsible party reached via telephone did not provide any additional evidence that would corroborate the allegations.

Resident R1 was admitted to the facility on June 22, 2021, and was the first admitted person once the license was obtained. Approximately 11 days after R1’s admission, R1 was taken to Orange Coast Memorial Emergency Department for decreased responsiveness and leg swelling. An Unusual Incident/Injury Report as submitted by the licensee on June 25, 2021 indicating that R1 was behaving aggressively towards staff members and displayed resistance to being provided with toileting care and having their diaper changed. The form submitted additionally states that “resident is not cooperative” and that R1’s responsible party was notified of the issue and requested to acquire “an air topper mattress that help to prevent [pressure injuries]”. Caregivers are reported to be using Calmoseptine and to be encouraging R1 to get out of bed. Email correspondence with R1’s responsible party was provided and indicates a diagnosis of gout which would be consistent with the leg swelling reported.

Regarding the allegations that Staff neglect resulting in resident developing pressure injuries, Resident developed a septic infection while in care and that Staff did not properly clean resident, the following has been concluded: Based on records reviewed and interviews conducted, the presence of pressure injuries upon R1’s hospitalization is confirmed, however correspondence and reports reviewed show measures taken by facility staff to prevent or mitigate the occurrence were also in place. There is insufficient evidence to demonstrate whether staff negligence was or could have been a contributing factor in the septic infection reported. Finally, repeated attempts to provide toileting care were reported but could not be confirmed due to a lack of evidence.

As a result, the three allegations are found to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2