197800835-2-23-2023-28-AS-MVAO-CPCTJE-20230224134613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800835
Report Date: 02/23/2023
Date Signed: 02/23/2023 01:57:08 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
07/21/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210721145509

FACILITY NAME:	HEGLIS CARE HOME		FACILITY NUMBER:	197800835
ADMINISTRATOR:	MILLET PINEDA		FACILITY TYPE:	735
ADDRESS:	3218 HEGLIS AVE.		TELEPHONE:	(626) 280-0061
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY:	4	CENSUS: 3	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Melissa Ruga, DSP		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Resident sustained a fracture while in care.
Staff refused to allow resident to use the facility phone.
Staff did not report resident injuries.
Staff did not seek medical assistance for the resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint visit to deliver findings on the above allegations. The purpose of the visit was discussed with DSP staff Melissa Ruga.

The investigation consisted of the following: On 7/22/2021, a health & safety check of facility clients, physical plant tour, client (C2) and staff (S2-S3) were interviewed regarding allegations #2-#4. On that date, client (C1) was not interviewed because on July 1, 2021, they had been relocated to another Adult Residential Facility (ARF) on July 1, 2021. Client (C2) and staff (S2-S3) were interviewed regarding allegations #2 - #4. The following documents were requested: ID/Emergency Information, Physician Report, appraisals, Regional Center IPP, 2021 incident reports, clinic visit report, hospital discharge documents, facility notes, admission agreement, client, roster, LIC 500 Personnel Report, staff schedule, staff tel. #'s, staff (S1's) Personnel Record, CPI Card, and MD report. On 7/23/2021, 2 Behavior Reports dated 2/27/21 & 6/14/21 were emailed. CDSS IB Investigators R. Kujawa & Zertuche conducted additional interviews with staff, family and attempted to interview former client (C1); but the client was unwilling.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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-20210721145509

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: HEGLIS CARE HOME	FACILITY NUMBER: 197800835
	VISIT DATE: 02/23/2023

NARRATIVE

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Allegation: “Staff did not seek medical assistance for the resident.” It is alleged that facility staff did not seek medical care for client (C1) after the 6/12/21 altercation between the client and staff (S1). According to medical record review, police report, and interviews, bruising began to show on 6/14/2021. The facility Administrator called client (C1's) Primary Care Physician on 6/15/21 and an appointment was scheduled for 6/16/21. Client (C1's) daughter requested to take the client and staff to the doctor's appointment. No evidence was found to support the allegation. The client had no visual injuries and denied treatment at the time of the injury. There is insufficient evidence to prove the allegation.

Based on record review and interviews conducted the findings indicate, although the allegation(s) may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

An exit interview was conducted with DSP staff Melissa Ruga. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210721145509

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: HEGLIS CARE HOME	FACILITY NUMBER: 197800835
	VISIT DATE: 02/23/2023

NARRATIVE

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Allegation: Resident sustained a fracture while in care. It is alleged that on 6/12/2021, client (C1) sustained physical injuries due to a physical altercation with staff (S1) resulting in bruising, swelling, and left arm fracture. This allegation was investigated by DSS Investigations Branch. On 6/12/2021 at approximately 0900 hours, client (C1) became upset when phone calls to family and boyfriend were not answered, and as result C1 became aggressive with staff (S1). The client threw the house phone at staff (S1's) head, and other items all over the house ground. Staff (S1) ran to the restroom and attempted to close the door, and C1 began to push the door with an attempt to punch staff (S1). The staff was able to run out of the restroom and was followed by the client. When the client was following staff (S1) it lost it's balance and fell on the floor. Client (C1) was interviewed by law enforcement at the hospital on June 16, 2021; and provided conflicting statements/stories about the incident. Based on client and staff interviews, the findings indicate client (C1) was the aggressor at the time of the incident. Medical records indicate the injury is in line with a fall, matching the statements from the facility staff. There is no evidence to support the allegation.

Allegation: “Staff refused to allow resident to use the facility phone.” It is alleged that on 6/12/2021, facility staff denied client (C1) access to the house telephone. According to staff and family interviews, client (C1) called family shortly after using the house telephone to make calls to boyfriend and daughter. The calls were not answered. The client became angry and in an attempt to calm the client down staff (S1) called C1's daughter. The facility has 2 telephones in the facility. Clients use the black telephone in the dining room. All staff denied the allegation, stating the client frequently made and received calls from boyfriend and family. There is insufficient evidence to prove the allegation.

Allegation: “Staff did not report resident injuries.” It is alleged that facility staff did not notify client (C1's) family about injuries sustained during the 6/12/2021 altercation between C1 and staff (S1). Based on record review and interviews conducted, the findings indicate that the client had no visual injuries at the time of the injury. On June 17, 2021, facility staff faxed Community Care Licensing an incident report regarding the 6/12/21 incident. Per Title 22 80061(b), Reporting Requirements. "Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event." Administrator left a voicemail message to LPA on 6/12/2021. Client (C1's) daughter was notified as soon as (6/15/21) staff noticed bruising on C1's arm. The client did not complain of pain and there were no visible injuries.

See next page

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

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