197603739-5-16-2025-28-AS-DSIS-DHDPPW-20250606113009

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603739
Report Date: 05/16/2025
Date Signed: 05/16/2025 04:22:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/23/2024 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20240923220543

FACILITY NAME:	MENTONE HOUSE		FACILITY NUMBER:	197603739
ADMINISTRATOR:	ROBIN PHILLIPS		FACILITY TYPE:	735
ADDRESS:	1980 MENTONE		TELEPHONE:	(626) 398-5629
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	6	CENSUS: 5	DATE:	05/16/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Magdalena Estrada - Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not meet a client's medical needs while in care.
Staff did not address a client's change in vision while in care.
Staff did not prevent a client from choking another client while in care.
Staff hit a client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit to
investigate the above allegations. LPA met with Margaret Estrada, Administrator and discussed the
purpose of today's visit.

The investigation consisted of the following: On 10/01/2024, LPA conducted a tour of the facility's common areas including clients' bedrooms and obtained copies of Client & Staff Rosters, Client #1 (C1) files such as; Identification & Emergency Information (Face sheet), Physician's Report, Admission Agreement, Pre-Placement Appraisal, IPPs, Client Personal Rights, Care notes, Unusual Incident/Injury Reports and Medication Administration Records (MARs for Nov. 2023 - Feb. 2024). LPA interviewed Staff #1 (S1) - Staff #4 (S4). LPA attempted to call the Service Coordinator at Frank D. Lanterman Regional Center by phone 3x (10/01/2024, 11/18/2024 and 12/09/2024) , but no response received. On 05/13/2025, LPA attempted to interview Client #1 (C1) - Client #2 (C2) on the phone but unsuccessful due to their cognitive abilities.
During today's visit, LPA obtained a copy of the Client & Staff Rosters, Staff in-service training log for clients rights, abuse and zero tolerance policy. LPA attempted to interview Client #3 (C3) - Client #4 (C4) in person but unsuccessful due to their cognitive limitations.*****CONTINUED ON LIC9099-C*****

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

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-20240923220543

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MENTONE HOUSE	FACILITY NUMBER: 197603739
	VISIT DATE: 05/16/2025

NARRATIVE

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The investigation revealed the following:

In regards to the allegation: “Staff did not meet a client's medical needs while in care.” It is alleged that C1 was ordered to use a CPAP machine and was required to have her blood tested twice daily and prescribed medication to manage diabetes, but the staff has done nothing. (4) out of (4) staff interviewed denied the allegation. S1 indicated that C1's physician recommended a CPAP machine for C1's sleep apnea, but when the doctor attempted to put it on C1 at the hospital, C1 refused. Additionally, S1 stated that the medication to control C1's blood sugar level was discontinued by the doctor due to C1 had severe allergic reaction. As a result, a different strategy was developed, including modifying dietary patterns, and joining a gym to workout. Some staff members interviewed indicated that they knew that C1 needed a CPAP machine but that it was never ordered because C1 wouldn't use it. Some staff interviewed indicated that despite encouraging C1 to use a CPAP machine for her well being, C1 had a strong will and continued to refuse. LPA attempted to contact the Service Coordinator at the Regional Center but was unsuccessful due to no response received. LPA also attempted to interview (4) clients who lived with C1, but unsuccessful due to their cognitive abilities. Therefore, there was insufficient evidence to corroborate with this allegation.

In regards to the allegation: “Staff did not address a client's change in vision while in care.” It is alleged that in April 2023, it was discussed that C1 needed to get her eyeglasses, which was delayed and never followed through. (4) out of (4) staff interviewed denied the allegation. Some staff interviewed stated that they are aware that C1 had an eye exam but there were no issues and no order for eyeglasses. Some staff interviewed indicated that C1 enjoyed watching TV and staff did not observe any changes in C1's vision that would raise concerns. LPA reviewed the optical prescription (dated 01/08/2025) and revealed that there was no eyeglass prescription had been found for C1. LPA attempted to contact the Service Coordinator at the Regional Center but was unsuccessful due to no response received. LPA also attempted to interview (4) clients who lived with C1, but unsuccessful due to their cognitive abilities. Therefore, there was insufficient evidence to corroborate with this allegation.

***CONTINUED ON LIC809-C***

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240923220543

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MENTONE HOUSE	FACILITY NUMBER: 197603739
	VISIT DATE: 05/16/2025

NARRATIVE

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In regards to the allegation: “Staff did not prevent a client from choking another client while in care.” It is alleged that in April 2023, C1 claimed that someone at the facility was choking her, causing her to pass out. (4) of (4) staff interviewed remembered an incident involving a former client who used to live in the facility, who was aggressive and tried to choke C1. The incident, however, happened on the transportation bus on the way to the Program. LPA reviewed an incident report (SIR) submitted to CCL on 04/10/2023, which stated that C1 was on the bus on her way to the day program when C2 choked her from behind. C1 did not suffer any injuries and medical treatment was not needed. Some staff interviewed indicated that there was never a choking incident at the facility during their shifts. Due to a lack of response, LPA was unable to speak with the Service Coordinator at the Regional Center. LPA also attempted to interview (4) clients who lived with C1, but unsuccessful due to their cognitive abilities. Therefore, there was insufficient evidence to corroborate with this allegation.

In regards to the allegation: “Staff hit a client while in care.” It is alleged that a staff member has hit C1. No other details provided. All (4) staff interviewed denied the allegation. S1 stated that she never smacked C1. S1-S2 stated that all staff were advised to clock out (with pay) if they were feeling stressed. Staff interviewed stated that none of the staff would ever hit or physically abuse a client. And that if a staff member gets to a client, they are fired immediately as the facility has zero tolerance policy that prohibits such behavior. LPA did not observe any bruises or cuts on the clients nor any signs of being withdrawn during the visit. LPA made several attempts to contact the Service Coordinator at the Regional Center but was unsuccessful due to no response received. LPA also attempted to interview (4) clients who lived with C1, but unsuccessful due to their cognitive abilities. Therefore, there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided to Magdalena Estrada, Administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

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