<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191500496
Report Date: 06/11/2024
Date Signed: 06/11/2024 11:23:04 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240603153809
FACILITY NAME:MOUNT SAN ANTONIO GARDENSFACILITY NUMBER:
191500496
ADMINISTRATOR:JOYCE FREMPONGFACILITY TYPE:
741
ADDRESS:900 EAST HARRISON AVENUETELEPHONE:
(909) 624-5061
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:520CENSUS: 452DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Joyce Frempong - Administrator TIME COMPLETED:
11:37 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure to provide a safe environment in the dining room
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Joyce Frempong and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff and resident roster. LPA interviewed 8 residents and 6 staff and conducted a tour of the dining room.

The investigation revealed the following: Regarding allegation: Staff did not ensure to provide a safe environment in the dining room. It is alleged residents had hot coffee spill on them due to coffee cup lids not fitting properly. During tour of the dining room, LPA observed a coffee station, which provides disposable cups and lids next to their self-serve coffee machine. Staff place a lid over a coffee cup which closed and fit properly. Interviews conducted revealed 8 out of 8 residents stated they feel safe at the facility, facility provides a safe environment throughout, and in the dining room. (CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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 28-AS-20240603153809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MOUNT SAN ANTONIO GARDENS
FACILITY NUMBER: 191500496
VISIT DATE: 06/11/2024
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
Per residents they have not have any issues with the coffee cups or lids and have not observed any resident spill coffee or hot beverages on themselves due to the coffee lids not fitting on the coffee cups. Interviews with staff revealed 6 out of 6 staff have not observed any residents spill coffee on themselves, residents have not notified staff regarding spilling coffee or hot beverages on themselves. Per administrator, there haven’t been any incidents in which residents have spills coffee or a hot beverage on themselves that may have been reported or needed first aid/medical care. Executive chef, who oversees ordering kitchen supplies, explained that recently the distributor changed their coffee cups in their delivery order, once staff became aware of lids not fitting cups properly, new lids were order. The change of cups and lids has been done in the last 7 days and there are no current issues. Per staff the new lids were order within 24 hours from the moment they became aware of the issue.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Joyce Frempong and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2