191603205-11-14-2022-11-AS-JHAD-CM3UGW-20221213143501

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191603205
Report Date: 11/14/2022
Date Signed: 11/14/2022 12:08:07 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
09/25/2022 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220925085154

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: 37	DATE:	11/14/2022
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Robert Arguilos, Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff does not treat resident with dignity or respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with , Robert Arguilos, Administrator.

The investigation consisted of following: Interviews and Record reviews. On 09/30/22, LPA Soto interviewed S#1 -Director of Nursing - S#4. LPA requested and received the following documents on 09/30/22: Face sheets, Pre-Appraisals, Physician's Report for R#1 - R#3, Staff training for S#5 & S#6, Needs and Serices Plan, and Incident Reports. On 10/26/22, LPA Soto conducted interviews with R#1 - R#5. The LPA toured the 1st floor with Sorenia. Rooms 125, 104, 112, 127, 133, nursing station, lounge, and laundry room. LPA observed staff inter-acting with R#2 - R#5, staff was being helpful and pleasant with residents.

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: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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-20220925085154

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: 11/14/2022

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following;

For Allegation – Staff does not treat resident with dignity or respect.
Interviews with S#1 - S#4, communicated that they always treat every residents with respect and dignity. They all appreciate and love all the resident in the facility. They always go above and beyond for every one of the residents. Some are getting care that they do not even for. R#1 communicated that R#1 is very shy and it's hard for R#1 to make friends. R#1 has a couple of friends that R#1 attends church with, but for the most part R#1 stays in R#1 room. R#1 tries to be very independent, so the care givers won't need to help R#1. R#1 explained that all the staff is great, but sometimes R#1 gets depressed and that's why she sometimes makes things up in R#1's mind. R#2 -R#5, communicated the staff is great and they have never felt dis-respected by any of the staff. The staff goes above and beyond to make the residents feel comfortable and happy. The staff is great with all the residents. LPA reviewed R#1 Care Plan, it showed that R#1 suffers from paranoia and hallucinations. The interviews conducted and records reviewed do not concur with the above allegation.

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 Robert Arguilos, Administrator, and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

LIC9099 (FAS) - (06/04)

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