197603725-8-25-2023-11-AS-MVAO-CWKUT7-20231013155124

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603725
Report Date: 08/25/2023
Date Signed: 08/25/2023 02:47:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
07/03/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20230703155214

FACILITY NAME:	ST. RICHARD PAMPURI		FACILITY NUMBER:	197603725
ADMINISTRATOR:	EDGARDO B. GALANG		FACILITY TYPE:	740
ADDRESS:	2458 S. ST. ANDREWS PLACE		TELEPHONE:	(323) 731-0641
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90018
CAPACITY:	70	CENSUS:	DATE:	08/25/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:			TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are imposing restrictions on resident’s visitation.

INVESTIGATION FINDINGS:

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On 08/25/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the faciliy listed above. LPA Gibbs met with Assistant Administrator, Arjene Aguirre, and Administrator, John Paul Cosico, and the purpose of today's visit was explained.

During today's visit, LPA Gibbs toured the facility and conducted staff interviews with staff (S4 and S5).

During a previous visit on 07/03/23, LPA toured the facility, interviewed staff (S1-S3), interviewed residents (R1-R7), and reviewed and received copies of Staff Roster, Resident Roster, Admissions Agreement, Resident Handbook, Activity Schedule, and resident’s Needs and Service Plan, Physicians Report, and Pre-Appraisal.

The investigation revealed the following:
CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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-20230703155214

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ST. RICHARD PAMPURI	FACILITY NUMBER: 197603725
	VISIT DATE: 08/25/2023

NARRATIVE

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Allegation: Staff are imposing restrictions on resident’s visitation.

The allegation alleged that staff are restricting a resident’s ability to use their wheelchair to go and see other people in other buildings.

Durning interviews with Administrator (A1), stated the facility has a resident who like to go over to one of the other buildings on campus for meals. Due to their level of care and being non-ambulatory, it requires a staff from their building to accompany them to the other building for meals which takes away staff from their building. Interviews with Administrator and Staff (A1 and S1-S5) six out of six stated the resident goes over to the independent living building for lunch 2-3 times a week depending on staffing. Additionally, six out of six staff stated that there are opportunities for residents from the other buildings to come over for morning exercise, they come to do activities and outings, and there are events where all the buildings get together. Interviews with Residents (R1-R7), seven out of seven stated they are provided activities where they are able to interact with residents from the other buildings. Additionally, six out of seven residents stated their personal rights are respected by staff. During the tour, LPA observed morning exercise, water aerobics, and activities, where residents from all buildings were involved and visiting. LPA reviewed activity scheduled and saw multiple activities and events for residents from all buildings to be together and interact.

Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

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