197800633-10-31-2024-28-AS-RORN-DASU5D-20241107141633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800633
Report Date: 10/31/2024
Date Signed: 10/31/2024 04:02:47 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
04/04/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240404133216

FACILITY NAME:	JOMAR RESIDENTIAL CARE CENTER		FACILITY NUMBER:	197800633
ADMINISTRATOR:	JOSEPHINE SAPALARAN		FACILITY TYPE:	735
ADDRESS:	3920 N FRIJO AVE		TELEPHONE:	(626) 338-4551
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	4	CENSUS: 4	DATE:	10/31/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Staff S1 Carrie Malinay		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet clients dental hygiene needs
Staff did not meet client's grooming needs
Staff did not ensure client was appropriately dressed
Staff mismanaged client's medication
Staff are not able to communicate with clients due to a language barrier
Staff confine clients to the sofa

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced subsequent complaint visit investigation for the allegations listed above. During today’s visit Staff S1 Carrie Malinay greeted LPA who explained the purpose of today's visit regarding the above-mentioned allegations.
The initial visit was conducted on 04/09/2024 and the Investigation consisted of the following: interview with Omar Sapalaran, Assistant Administrator. LPA reviewed Client C1's file and various documents to be submitted. LPA obtained copies of staff and client roster. All 3 client's were attending their Day Program at time of today's visit.
LPA toured the facility along with Omar Sapalaran, Assistant Administrator which included 4 Client bedrooms, 2 client bathrooms, dining room, television and backyard area.
At today's visit attempts were unsuccessful to interview Client's C1 and C2 who are non verbal and unable to respond to questioning. Interview was conducted with Client C3. Client C4 was as at Day Program.
Interviews were conducted with Staff S1 and Staff S2.
In regards to the allegation Staff did not meet clients dental hygiene needs, based on interviews conducted

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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 3

Control Number 28-AS-20240404133216

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: JOMAR RESIDENTIAL CARE CENTER	FACILITY NUMBER: 197800633
	VISIT DATE: 10/31/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

and information gathered Administrator revealed that Client C1 has been with him for 28 years and it has gone smoothly with nothing wrong.
Stated that staff are all trained in tooth brushing assistance and that Client C1's medication is a big contributor to. tooth loss and tooth decay.
Interview with Staff S1 and S2 who both stated that every morning before showering and also during the PM shift tooth brushing is done. Both stated that his teeth is always cleaned.
Interview with Client C3 who stated that his teeth are brushed everyday and this morning they did it.
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.

In regards to the allegation Staff did not meet client's grooming needs based on interviews conducted and information gathered the Administrator stated that they will shave Client C1 every other day and can't everyday because of irritation.
LPA attempting to interview Client C1 observed him to be clean shaven.
Interview with Staff S1 and Staff S2 stated that shaving is always done and if they notice beard stubble they will shave them. Said before Day Program they check to make sure his appearance is all in order.
Said they shave Client C1 every other day.
Interview with Client C3 who stated he was shaved this morning and they do it for all the clients.
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.
In regards to the allegation Staff did not ensure client was appropriately dressed, based on interviews conducted and information gathered the Administrator stated that Client C1 has a very thin backside and that is why his pants are falling. Said they have 2 belts in the drawer for him.
LPA observed Client C1 pulling up his pants and confirms the Administrator statement above.
Interview with Staff S1 and S2 who stated that Client C1 has no backside and he has pants with strings to tighten it. If jeans has to wear a belt. Also stated that he sometimes will take his belt off.
Interview with Client C3 who stated that in his room they help with his clothes. Said they help Client C1 also get dressed everyday.
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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20240404133216

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: JOMAR RESIDENTIAL CARE CENTER	FACILITY NUMBER: 197800633
	VISIT DATE: 10/31/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In regards to allegation Staff mismanaged client's medication, based on interviews conducted and information gathered Administrator revealed that Client C1 has never been administered the wrong medication and has been here 28 years.
LPA reviewed Client C1's medication for October 2024 which had been administered per physicians directions. Interview with staff who stated that each medication has a name and a picture of the client.
Said they will double check the medication and the MAR log.
Stated there is also a 2nd checker to verify that the medication was given correctly. Interview with Client C3 who stated that it is given to all clients everyday in the kitchen and said they gave it to him this morning.
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.
In regards to the allegation Staff are not able to communicate with clients due to a language barrier, based on interviews conducted and information gathered interviews were conducted with Staff S1 and Staff S2 who both were observed communicating in English with the clients and also communicating very well with the LPA at today's visit. Interview with Administrator who stated that out of 12 staff only 1 who might be limited, but said there are 3 staff on duty who can assist if needed.
Interview with Staff S1 and S2 who stated that they respect all clients and speak in English and said only 1 staff who speaks Spanish, but also speaks English.
Interview with Client C3 who stated that he has no problem communicating with staff.
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.
In regards to the allegation, Staff confine clients to the sofa, based on interviews conducted and information gathered it was observed during today's visit that Client C1 was not confined to the couch. Client C1 would constantly jump up and go into different areas of the facility.
Interview with the Administrator who stated that Client C1 is able to walk around. Stated he will take papers off the wall and staff may direct to the couch, but he is able to exercise his legs.
Interview with staff who stated that Client C1 plays with building blocks at dining room and also he will walk everywhere. Will go to the kitchen, dining room, and anywhere he wants to.
Interview with Client C3 who stated that they can move around and go anywhere.
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.
It should also be noted that the findings of the Investigation by the San Gabriel Pomona Regional Center were Unsubstantiated.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3