191592287-6-17-2022-28-AS-FFIS-CFQ3MA-20220624182200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592287
Report Date: 06/10/2022
Date Signed: 06/17/2022 04:01:43 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 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
01/22/2021 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210122162233

FACILITY NAME:	MASONIC HOMES FOR ADULTS		FACILITY NUMBER:	191592287
ADMINISTRATOR:	JUDY FIGUEROA		FACILITY TYPE:	741
ADDRESS:	1650 EAST OLD BADILLO ST		TELEPHONE:	(626) 251-2200
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	112	CENSUS: 60	DATE:	06/10/2022
		UNANNOUNCED	TIME BEGAN:	12:55 PM
MET WITH:	Administrator Sandra Fahey		TIME COMPLETED:	04:18 PM

ALLEGATION(S):

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Staff is retaliating against a resident while in care.
Resident is not afforded privacy while in care.
Staff threatens a resident while in care.
Staff is interfering with a resident's medical needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Valeria Maldonado conducted a subsequent unannounced complaint investigation visit regarding the above mentioned allegations. The initial visit was conducted telephonically by LPA Tao on 01/29/21, who met with administrator Judy Figueroa.
LPA Maldonado met with administrator Sandra Fahey today and explained the reason for the visit.

The investigation consisted of the following: 1 staff and 1 resident were interviewed during the initial complaint visit. LPA requested the following records for Resident #1’s (R1) to Resident #6 (R6): Physician report; Identification and Emergency information; Appraisal; and Need and service plan.
LPA also requested R1’s Incident reports from April 2020 to current, complaint notes from R1, R1’s eviction letters from 2020 to current, documents regarding where surveillance cameras are installed, and document about where cameras are focusing on.
The investigation revealed the following: Allegation- Staff is retaliating against a resident while in care.
(Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

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 28-AS-20210122162233

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MASONIC HOMES FOR ADULTS	FACILITY NUMBER: 191592287
	VISIT DATE: 06/10/2022

NARRATIVE

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R1 stated the facility installed cameras as a form of retaliation against them. (8) of (9) residents interviewed stated they have not been, and have no knowledge of any resident being retaliated against by staff at the facility. A review of the surveillance videos conducted during the visit revealed that all (36) cameras are used to record roadways, hallways, parking lots,and common areas. None are focused on resident apartments. Although the allegations may have happened or are valid, there is not a preponderance of evidence standard to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Allegation- Resident is not afforded privacy while in care.
R1 stated that a surveillance camera was installed pointing directly at their window. A review of the surveillance videos conducted in the maintenance facility offices revealed that all (36) cameras are used to record roadways, hallways, parking lots, and common areas. The camera that was alleged to be installed to record R1's window is focused on the roadway behind their home and happens to catch part of their window as part of the picture. (8) of (9) residents interviewed stated they feel comfortable and are given their privacy by all staff. Although the allegations may have happened or are valid, there is not a preponderance of evidence standard to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Allegation- Staff threatens a resident while in care.
R1 stated that Staff #3 (S3) was harassing/threatening R1 by following them in the facility golf cart with no headlights on. A letter was obtained by the facility regarding an interview conducted with S3 and R1 by Staff
#1 (S1) indicating the matter was addressed. S#3 admitted to driving with no headlights on as to not bother R1's eyes, not to harass/threaten them. The lights were turned immediately on again after passing R1. (8) of (9) residents interviewed stated they have never been harrassed or felt threatened by any staff at the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence standard to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Allegation- Staff is interfering with a resident's medical needs.
R1 stated they requested to make an appointment with their doctor and S1 told Staff# 4 (S4) to not make the appointment for them. Interview with S1 and S4 indicated that medical requests/needs were never refused. S1 was independent and did not need assistance with ADL's. (8) of (9) residents interviewed stated S4, nor any staff, have ever refused to assist with any medical needs/requests. Although the allegations may have happened or are valid, there is not a preponderance of evidence standard to prove the allegation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview was conducted with Administrator Sandra Fahey and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2022

LIC9099 (FAS) - (06/04)

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