197606284-1-9-2024-28-AS-RORN-CZE24T-20240111160427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606284
Report Date: 01/09/2024
Date Signed: 01/09/2024 01:26:14 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 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
06/01/2023 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230601085850

FACILITY NAME:	ST. JUDES HOMES FOR THE ELDERLY III		FACILITY NUMBER:	197606284
ADMINISTRATOR:	TERRY B. MCGEE		FACILITY TYPE:	740
ADDRESS:	4942 BUFFINGTON ROAD		TELEPHONE:	(909) 936-5424
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91732
CAPACITY:	6	CENSUS: 6	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	12:27 PM
MET WITH:	Virgie Vicente- House Manager		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made a subsequent, unannounced complaint visit to the facility for the purpose of delivering findings for the complaint with the above-mentioned allegtion. LPA Maldonado met with House Manager, Virgie Vicente, and explained the purpose for the visit.

On 06/08/2023, LPA Kruz Long made an initial complaint visit. During the visit, LPA Long obtained a copy of the Staff schedule, Resident roster and Hospice records for Resident# 1 (R1). Interviews were also conducted with Staff #1 and #2 (S1-S2), attempted to interview Staff #3 (S3), interviewed Resident #2 (R2) and #6 (R6) and attempted to interview R1, residents #3, #4, and #5 (R1, R3, R4, and R5). LPA Long also made an attempt to interview local law enforcement.

During today's visit, LPA Maldonado obtained Facesheet and attempted to interview S3 and local law enforcement, via telephone, but was unsuccessful.
(Report Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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-20230601085850

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST. JUDES HOMES FOR THE ELDERLY III	FACILITY NUMBER: 197606284
	VISIT DATE: 01/09/2024

NARRATIVE

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The investigation revealed the following:
Regarding allegation: Staff handled resident in a rough manner.
It is alleged that during a visit for R1 from hospice to provide care and replace a device, S1 came and grabbed R1's wrists and pulled R1's hands over R1's head, while R1 yelled in pain. Per interview with S2, S2 stated that the hospice physician asked S2 to assist with R1 by holding R1's hands. S2 stated that when S2 grabbed R1's hands, R1 began to shout. S2 let go of R1's hands and S1 came in to assist the physician. S2 denied handling the resident in a rough manner. Per interview with S1, the physician requested S2 to assist with holding R1's hands due to R1 pulling on the device that the hospice physician was attempting to replace on R1. S1 stated that when S2 grabbed R1's hands, R1 began shouting due to R1's cognitive impairment. S1 states that R1 regularly shouts due to cognitive impairment. S1 states that when S1 went to hold R1's hands, R1 stopped shouting. S1 also denied handling a resident in a rough manner. Per R1's hospice records, R1 suffers from cognitive impairment. (2) of (6) residents denied being handled in a rough manner by staff. (4) of (6) residents attempted to be interviewed could not corroborate the allegation.

Based on interviews and observations conducted, there was not enough supportive evidence to concur with the reported allegations. 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 and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

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