197800633-8-8-2023-28-AS-FFIS-CUS23A-20230816170159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800633
Report Date: 08/08/2023
Date Signed: 08/08/2023 04:49:45 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
08/03/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230803092446

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:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Omar Sapalaran, assisted administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff not provided with proper training to provide care and supervision to residents.
Facility canned food is expired.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met with Omar, assisted administrator. LPA explained the purpose of today's visit regarding the above-mentioned allegations.

Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #4 (S4); attempted to interview clients from client#1 (C1) to client#4 (C4); reviewed staff files for training records and work schedules with timecards; and toured the facility and kitchen. LPA obtained copies of staff and client rosters; and staff files with relevant information.

In regard to allegation of “staff not provided with proper training to provide care and supervision to residents,” it was alleged that facility did not provide proper training to staff and supervision to clients due to under staff. ( - continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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-20230803092446

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: 08/08/2023

NARRATIVE

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The investigation revealed the following: LPA attempted to interview clients, all four (4) clients interviewed could not corroborate the allegation. All four (4) staff interviewed denied the allegation. Regarding staff training, staff interviews revealed facility provided proper training to new staff upon employment and the annual in- service training to the current staff. File review revealed that staff had received in service training at least 12 hours/year and new hired had to complete the required training upon hiring day. Regarding staff to provide supervision, as reviewed staff’s work schedules and cross checked them with staff’s timecards, facility had at least two (2) staff per each shift for client census of four (4). Only the time from 9am to 2pm during the weekday would be one (1) staff because clients were attending their day programs. Therefore, facility had provided staff with proper training to provide care to clients and staff had provided proper supervision to clients while in care.

In regard to allegation of “facility canned food is expired,” it was alleged that facility had expired canned food in their food supply. The investigation revealed the following: LPA attempted to interview clients, all four (4) clients interviewed could not corroborate the allegation. All four (4) staff interviewed denied the allegation. Staff interviews revealed staff would check the expiration day before using the canned food and throw away all expired canned food if found. LPA toured the kitchen and checked all canned food. No expired canned food was found. Therefore, facility did not have expired canned food.

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 allegations is UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Omar, assisted administrator. A hard copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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