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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603725
Report Date: 06/22/2022
Date Signed: 06/22/2022 12:12:52 PM

Unfounded


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
MONTERY 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 Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220621112409
FACILITY NAME:ST. RICHARD PAMPURIFACILITY NUMBER:
197603725
ADMINISTRATOR:SABRINA TUCKERFACILITY TYPE:
740
ADDRESS:2458 S. ST. ANDREWS PLACETELEPHONE:
(323) 731-0641
CITY:LOS ANGELESSTATE: CAZIP CODE:
90018
CAPACITY:70CENSUS: 30DATE:
06/22/2022
UNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Edgardo GalanTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal Rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 6/22/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint investigation at the facility listed above. LPA spoke with Administrator Edgardo Galan prior to entering the facility and was informed facility has no cases of covid-19, nor do the clients have any signs or symptoms. LPA arrived at facility and was greeted by staff. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted entry.

Continued on 9099-C

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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 11-AS-20220621112409
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
MONTERY PARK, CA 91754
FACILITY NAME: ST. RICHARD PAMPURI
FACILITY NUMBER: 197603725
VISIT DATE: 06/22/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Personal Rights
Based on a review of resident and staff rosters it was determined that resident 1 (R1) does not reside at this facility. LPA Cifuentes found that R1 has never been a resident at this facility. LPA found that R1 resided at a skilled nursing facility located adjacent to the assisted living facility. LPA received admissions record for R1 confirming dates of admittance to skilled nursing facility as well as their last date of residence. LPA received a letter from director of skilled nursing that confirms that resident lived solely at the skilled nursing facility and not at the assisted living facility. LPA spoke with witnesses (W1-W2) who confirmed that resident resided in skilled nursing and not at assisted living facility.

This agency has investigated the complaint alleging "Personal Rights". We have found that the complaint is unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted and a copy of this report was provided to administrator Edgardo Galan.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2