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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607902
Report Date: 10/24/2023
Date Signed: 10/24/2023 03:30:04 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
04/05/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230405095642
FACILITY NAME:ST. MICHAELS HOME FOR THE ELDERLYFACILITY NUMBER:
197607902
ADMINISTRATOR:JAMES MCGEEFACILITY TYPE:
740
ADDRESS:1506 S. CANDISH AVENUETELEPHONE:
(951) 532-4644
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:0CENSUS: 6DATE:
10/24/2023
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Barbara Boiston, House ManagerTIME COMPLETED:
03:49 PM
ALLEGATION(S):
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Facility staff is physically abusing resident in care
Facility staff yell at resident in care
Facility staff threatened resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) made a subsequent visit to facility to provide additional information that was not included in the original report dated 04/10/2023 LPA met with Barbara Boiston and discussed the purpose of the visit.

Licensing Program Analyst (LPA) Alberto Lopez made an initial complaint visit at the facility on 04/10/2023 for the purpose of investigating the above-mentioned allegations. LPA Lopez met with caregiver Angelina Tupil and Barbara Boiston who arrived a short time later and LPA explained the purpose for the visit.

During today's visit, LPA Lopez requested a copy of the resident and staff roster, and the following documents for Resident# 1 (R1): Physician's Report, Pre-Placement Appraisal. LPA Lopez also conducted a tour of the physical plant and conducted interviews with Residents# 1-5 (R1-R5), Staff# 1-4 (S1-S4), and Witnesses 1-2 (W1-W2) who are family members.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
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 28-AS-20230405095642
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: ST. MICHAELS HOME FOR THE ELDERLY
FACILITY NUMBER: 197607902
VISIT DATE: 10/24/2023
NARRATIVE
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Regarding Allegation: Facility staff is physically abusing resident in care. It is alleged that one member of staff is physically abusing a resident.

LPA interviewed 4 staff S#1 -S#4 (S1-S4) during the visit and all 4 staff denied the allegations. Staff stated they have never observed any physical abuse by any staff on resident. LPA interviewed 5 residents R#1- R#5 (R1-R5) and 2 witnesses (W1-W2). The witnesses are family members of resident (s). 3 of 5 residents could not collaborate with the allegations. 3 residents stated they get good care at the facility and have never observed any kind of physical abuse by staff. 2 witnesses could not collaborate with the allegations and stated they are satisfied with the care at facility their family members receive.

Regarding Allegation: Facility staff yell at resident in care. It is alleged that one staff is yelling at a resident.

LPA interviewed 4 staff and all 4 staff denied the allegations. Staff stated they love the residents and would never yell at them. LPA interviewed 5 residents and 4 of 5 residents could not collaborate with the allegations. LPA interviewed 2 witnesses and 2 of 2 witnesses could not collaborate with the allegations and stated they are happy with the care at facility.

Regarding Allegation: Facility staff threatened resident in care. It is alleged that one staff told R1 to not report anything or R1 will have back broken. LPA interviewed 4 staff and all 4 staff denied the allegations. Staff stated they never threaten residents and have never observed other staff threatening residents. LPA interviewed 5 residents and 4 of 5 residents could not collaborate with the allegation. 4 of 5 residents stated they have never observed any staff threatening any of the residents and 4 residents stated they feel safe at the facility. Both witness state they are confident that residents are safe at the facility.

R1 has a history of fabrication, and reporting unsubstantiated allegations. On 12/23/2013, 08/20/2020 and 10/19/2022. Family of R1 collaborated this during phone call with LPA.

Barbara Boiston, House Manger stated that the local police department did not investigate the allegations, The Long-Term Care Ombudsman did not investigate the allegations. Adult Protective Services made visit to facility on 4/21/23 and did not initiate an investigation.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



An exit interview was conducted with House Manager Barbara Boiston and a copy of the report was provided along with appeal rights.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto LopezTELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2