197607902-4-10-2023-28-AS-RORN-CWYTQ9-20231026145530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607902
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:23:57 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 ELDERLY		FACILITY NUMBER:	197607902
ADMINISTRATOR:	JAMES MCGEE		FACILITY TYPE:	740
ADDRESS:	1506 S. CANDISH AVENUE		TELEPHONE:	(951) 532-4644
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	6	CENSUS: 5	DATE:	04/10/2023
		UNANNOUNCED	TIME BEGAN:	10:19 AM
MET WITH:	Barbara Boiston		TIME COMPLETED:	02:35 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) Alberto Lopez made an initial complaint visit at the facility 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# 1-3 (S1-S3), and Witnesses 1-2 (W1-W2)

Continued on 809C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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 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: 04/10/2023

NARRATIVE

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Regarding Allegation: Facility staff is physically abusing resident in care. It is alleged that one staff is physically abusing resident.

LPA interviewed 3 staff (S#1 -S#3) during visit and all 3 staff denied the allegations. Staff stated they have never observed any physical abuse by any staff on resident. LPA interviewed 5 residents (R1-R5) and 2 witness (W1-W2). 3 of 5 residents could not collaborate the allegations. 3 residents stated they get good care at facility and have never observed any kind of physical abuse by staff. 2 witnesses did could not collaborate the allegations and stated they are satisfied with the care at facility. LPA was unable to reach S4 as S4 is currently out of the country.

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

LPA interviewed 3 staff and all 3 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 the allegations. LPA interviewed 2 witness and 2 of 2 witness could not collaborate the allegations and stated they are happy with the care at facility. LPA was unable to reach S4 as S4 is currently out of the country.

Regarding Allegation: Facility staff threatened resident in care. It is alleged that one staff told resident to not report anything or R1 will have back broken. LPA interviewed 3 staff and all 3 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 the allegation. 4 of 5 residents stated they have never observed any staff threatening any of the residents and 4 residents stated they feel save at facility. Both witness state they are confident that residents are safe at the facility. LPA was unable to reach S4 as S4 is currently out of the country.

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 Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Alberto Lopez	TELEPHONE: 323-980-4926
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC9099 (FAS) - (06/04)

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