197800835-3-9-2023-28-AS-TVAO-CQ5N7W-20230321101323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800835
Report Date: 03/09/2023
Date Signed: 03/09/2023 03:51:32 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
06/18/2021 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210618121505

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:	03/09/2023
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Melissa Ruga/S-1		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not seek medical attention for client in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegation. LPA met with Maria Ruga/S-1 and discussed the purpose of today’s visit. During today's visit, LPA interviewed S-1.

On 06/23/2021, LPA Irra conducted the initial 10-day complaint visit. During the initial visit, LPA reviewed file for Staff #1 (S-1) and Client #1 (C-1) and obtained relevant documentation. LPA was unable to interview C-1 as C-1 moved out of this facility 07/01/2021. CDSS IB Investigators R. Kujawa & P. Zertuche conducted additional interviews with staff including (S-1), family and attempted to interview C-1 (C-1 was unwilling to be interviewed).

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

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-20210618121505

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: HEGLIS CARE HOME	FACILITY NUMBER: 197800835
	VISIT DATE: 03/09/2023

NARRATIVE

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Allegation: Staff did not seek medical attention for client in a timely manner It is alleged that facility staff did not seek medical attention for C-1 in a timely manner after the 06/12/2021 altercation between C-1 and S-1. It was revealed that C-1 was the aggressor at the time of this incident. Per CDSS IB Investigators R. Kujawa & P. Zertuche investigation, according to medical record review, police report, and interviews, bruising on C-1’s left shoulder began to show on 06/14/2021. The Facility Administrator contacted C-1's Primary Care Physician on 06/15/2021 and an appointment was scheduled for 06/16/2021. Per CDSS Investigators, there was no evidence found to support this allegation. C-1 had no visual injuries and denied treatment at the time of the injury. There is insufficient evidence to prove this 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) is UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Melissa Ruga/S-1

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2023

LIC9099 (FAS) - (06/04)

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