191603205-6-21-2022-11-AS-JHAD-CG8TEP-20220711144012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603205
Report Date: 06/21/2022
Date Signed: 06/21/2022 12:13:07 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
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220621080225

FACILITY NAME:	JEANNE JUGAN RESIDENCE		FACILITY NUMBER:	191603205
ADMINISTRATOR:	SISTER PAUL MAGYAR		FACILITY TYPE:	740
ADDRESS:	2100 SOUTH WESTERN AVENUE		TELEPHONE:	(310) 548-0625
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90732
CAPACITY:	62	CENSUS:	DATE:	06/21/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Mother Paul Magyar, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility does not have an administrator.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a complaint investigation for the abive allegation. Today’s complaint investigation was conducted with Mother Paul Magyar, the facility administrator

The investigation consisted of following: Interviews and Record reviews. On 06/21/22, LPA interviewed Mother Paul Magyar, Sister Coltilde (Administrator), Robert Aguilos -(SNF Administrator), and Dolores Kollmer- (Development Director.) LPA requested the following documents for Mother Paul. Renewed Administrator certificate.

Based on the LPA's investigation, the investigation revealed the following. For Allegation – Facility does not have an administrator. Interviews with Mother Paul, Sister Coltilde, Dolores, and Robert stated that there has always been an administrator at the facility. Mother Paul sent in renewal documents to sacramento, renewal application is being transferred. Mother Paul called sacramento for application status (In process.) Current administrator certificate expires in June 2022. Sister Coltide administrator certificate expires September 2022. There is an administrator working at the facility. Sister coltilde has been the administrator since 2017.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

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 11-AS-20220621080225

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
MONTEREY PARK, CA 91754

FACILITY NAME: JEANNE JUGAN RESIDENCE	FACILITY NUMBER: 191603205
	VISIT DATE: 06/21/2022

NARRATIVE

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There has always been an administrator overseeing the facility and the care of the residents. The facility will be sending a news letter to all resident to advise the residents on the sell of facility and who is the administrator.

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 allegation is unsubstantiated.

An exit interview was conducted with Mother Paul Magyar, Administrator, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2022

LIC9099 (FAS) - (06/04)

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