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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800835
Report Date: 10/15/2024
Date Signed: 10/15/2024 09:15:23 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/20/2024 and conducted by Evaluator Christian Gutierrez
COMPLAINT CONTROL NUMBER: 28-AS-20240920161038
FACILITY NAME:HEGLIS CARE HOMEFACILITY NUMBER:
197800835
ADMINISTRATOR:JANE ANNE CUAFACILITY TYPE:
735
ADDRESS:3218 HEGLIS AVE.TELEPHONE:
(626) 280-0061
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:4CENSUS: 3DATE:
10/15/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melissa Ruga DSPTIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Staff yelled at resident.
Staff did not allow resident to use the restroom.
Staff did not provide resident with adequate food service.
Staff are unable to communicate with residents due to language barrier.
INVESTIGATION FINDINGS:
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LPA Christian Gutierrez conducted a subsequent complaint visit in regard to the allegations listed above. LPA met with DSP worker Melissa Ruga and explained the purpose of the visit, Administrator Jane Cua was notified of the visit by phone.


The investigation consisted of the following: During the initial visit conducted on 09/27/2024, LPA Gutierrez interviewed Administrator, Staff #1 (S1) - Staff #2 (S2), Client #1 (C1) - Client #2 (C2), toured the facility, LPA obtained copies of the following documents: Staff roster, client roster, C1’s Individual Program Plan (IPP) report and behavior report. LPA interviewed additional staff over the phone on 10/04/2024.

See LIC 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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-20240920161038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HEGLIS CARE HOME
FACILITY NUMBER: 197800835
VISIT DATE: 10/15/2024
NARRATIVE
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In regard to the allegation that “Staff yelled at resident”, it is alleged that S1 yells at C2. During interviews with C1 and C2 none of them corroborated the allegation. C2 stated there was no problems at facility and C1 stated that staff is good and S1 is their favorite staff. During interviews with staff, none of them corroborated the allegation. S1 stated that yelling is wrong, and no yelling has been witnessed. S2 stated that speaking in a louder voice may be needed if they’re in a different room but not yelling at clients.

In regard to the allegation that “Staff did not allow resident to use the restroom”, It’s alleged that staff did not allow C2 to use women’s restroom when men’s restroom was occupied causing C2 to have a bowel movement in his/her room. During interviews with C1 and C2 both did not corroborate the allegation. Both stated that there is no issue with restrooms at facility. During interviews with staff, S2 stated that they have three restrooms, and all can be used if needed. It was reported that C2 was upset because both restrooms in the hallway were occupied and C2 was told to wait one second or use the one in kitchen. Allegedly C2 was upset and slammed the bedroom door. S2 stated that rooms were checked, and no bowel movement was found. Administrator stated all three restrooms are available for use. C2’s IPP report states that C2 has demanding behavior.

In regard to the allegation that “Staff did not provide resident with adequate food service”, It’s alleged that staff did not provide C2 with breakfast food requested. During interviews with clients, C1 stated that food is good. C2 stated food is slow and still hungry. During interviews with staff both stated that all meals are prepared by all staff and that clients have choices. LPA toured kitchen and saw a variety of fresh vegetables, produce, fruit, grains, and snacks. Interview with Administrator revealed that some requests are made, and she tries her best to provide items like fresh coffee and real butter not margarine and specific brands of food. However, they are not always able to accommodate.

In regard to the allegation that “Staff are unable to communicate with residents due to language barrier”, It is alleged that there is a new staff at the facility who does not speak English and would not know what to do in an emergency. During interview with staff, S2 stated that staff speaks English, but Spanish is primary language for new staff. Administrator states that staff knows basic English and is able to communicate with everyone in the facility. Administrator also stated that there are always two staff members on duty. LPA conducted a phone interview with staff in question and was able to conduct interview in English and obtain clear responses.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240920161038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HEGLIS CARE HOME
FACILITY NUMBER: 197800835
VISIT DATE: 10/15/2024
NARRATIVE
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Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3