197800633-5-31-2024-28-AS-FFIS-D5ZUEH-20240607153108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800633
Report Date: 05/31/2024
Date Signed: 05/31/2024 10:10:05 AM

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
01/10/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240110100222

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:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:			TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff physically abused a resident resulting in hospitalization.
Facility staff hit resident to wake them up.
Facility staff used inappropriate gesture to threaten resident.
Facility staff did not ensure resident had clean linens.
Facility staff did not provide hygiene care to resident.
Facility failed to provide residents with adequate food service.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the original complaint investigation report created on 02/27/24. The findings remain as unsubstantiated. ***

Upon arriving at the facility, LPA met with Omar Sapalaran, administrator. LPA explained the purpose of today’s visit which was to re-deliver the findings.

The initial 10-day visit was conducted on 01/11/24 and the subsequent visit was conducted on 02/27/24.

The investigation consisted of client interviews, staff interviews, facility tours, and review of facility records. LPA obtained client/staff roster, staff’s training records and clients’ facility files. For record reviews, LPA reviewed and obtained the San Gabriel Pomona Reg Center report regarding the investigation of the allegations which the findings were unsubstantiated. The Police report number (SDM 24010-0157) was provided but no further investigation was conducted. (-continued in LIC 9099C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20240110100222

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: 05/31/2024

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 02/27/24. The findings remain as unsubstantiated. ***

The investigation revealed the following:
In regards of facility staff physically abused a resident resulting in hospitalization, it was alleged staff twisted client’s feet and injured client which led to client’s hospitalization. LPA interviewed client#1 (C1) and attempted but unsuccessful to interview clients from client#2 (C2) to client#3 (C3). LPA spoke with C1 and C1 indicated staff were nice to clients. Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff stated they were not allowed to abuse clients in any forms because those were against Title 22 regulation.

Per LPA’s observation, staff were nice to clients and client#1 had a smile on client’s face during interview. Per record review, the incident report dated 8/4/23, stated the client fell on the floor while attending the day program. As a result, staff sent client to hospital for a medical check. Thus, the facility staff did not abuse clients while in care.

In regards of facility staff hit resident to wake them up, it was alleged that staff hit client’s arm to wake client up. LPA interviewed client#1 (C1) and attempted but unsuccessful to interview clients from client#2 (C2) to client#3 (C3). C1 indicated staff were nice to clients. Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff stated they were not allowed to hit, twist or abuse clients. Per LPA’s observation, clients often had a smile on their face during LPA’s visit. Thus, there was not preponderance evidence to show facility staff hit client to wake client up.

In regards of facility staff used inappropriate gesture to threaten resident, it was alleged that staff showed inappropriate hand gesture to threaten client at the facility. LPA interviewed client#1 (C1) and attempted but unsuccessful to interview clients from client#2 (C2) to client#3 (C3). Per client interview, client could not corroborate the allegation. Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff stated they were not allowed to threaten or degraded clients by using bad hand gesture. Clients had their personal rights of being treated with respect. Per LPA’s observation, clients were calm and did not observe staff threaten clients. Thus, there was not preponderance evidence to show facility staff threaten clients. (-continued in LIC 9099C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20240110100222

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: 05/31/2024

NARRATIVE

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***This report serves as an amendment and supersedes the original complaint investigation report created on 02/27/24. The findings remain as unsubstantiated. ***

In regards of facility staff did not ensure resident had clean linens, it was alleged that staff did not change client’s bed sheet after soiled. LPA attempted but unsuccessful to interview clients from client#1 (C1) to client#3 (C3). Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff stated they would change clients’ bedsheet / linens whenever it got soiled. Per LPA’s observation, clients’ beds were neat, and bedsheets were clean. Thus, clients had clean linens and bed sheets for use while in care.

In regards of facility staff did not provide hygiene care to resident, it was alleged staff did not clean client when client had bloody nose. LPA attempted but unsuccessful to interview from client#1 (C1) to client#3 (C3). Per staff interviews, all four (4) staff who were interviewed denied the allegation. Per record review, the client who had bloody nose was on one to one care at the facility. Staff was always next to that client. Per LPA’s observation, all clients were clean and neat. Thus, the facility had provided hygiene care to clients.

In regards of facility failed to provide residents with adequate food service, it was alleged that facility staff provide clients with the old food from restaurant and did not have fresh fruit. LPA attempted but unsuccessful to interview from client#1 (C1) to client#3 (C3). Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff stated they cooked fresh on every meal. Per record review, administrator made grocery shopping weekly. Per LPA’s observation, the facility had more than two days non-perishable food and seven days of perishable food. Thus, clients had adequate food service while in care.

Based on the information obtained during the investigation, interviews with staff, residents, review of resident files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

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

An exit interview was conducted with interim administrator, Omar. The findings were discussed. A copy this report was provided to Omar at time of visit.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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