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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801459
Report Date: 03/18/2024
Date Signed: 03/18/2024 03:30:21 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
03/15/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240315094754
FACILITY NAME:CASA SAHAGUN NUESTRO REFUGIOFACILITY NUMBER:
197801459
ADMINISTRATOR:GUADALUPE E. SAHAGUNFACILITY TYPE:
735
ADDRESS:14136 BRONTE DRIVETELEPHONE:
(562) 945-5530
CITY:WHITTIERSTATE: CAZIP CODE:
90602
CAPACITY:4CENSUS: 4DATE:
03/18/2024
UNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Guadalupe Sahagun, LicenseeTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff do not treat residents with respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with Administrator Guadalupe Sahagun.

The investigation consisted of: A physical plant tour of interior common areas and resident bedrooms was conducted.Staff (S1- S2), residents (R1- R4), family (F1), and Eastern Los Angeles Regional Center Service Coordinator were interviewed. Facility Plan of Operation "House Values"/ "Statement of Purpose" and resident file documents were reviewed. Copies of resident Identification and Emergency Information, Physician's Reports, Plan of Operation Statement of Purpose, LIC 500 Personnel Report, and Register of Facility Clients were obtained.


***See narrative summary on next page.***
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
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 2
Control Number 28-AS-20240315094754
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: CASA SAHAGUN NUESTRO REFUGIO
FACILITY NUMBER: 197801459
VISIT DATE: 03/18/2024
NARRATIVE
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Allegation: Staff do not treat residents with respect. It is alleged that Licensee/DSP staff (S1) does not treat residents with respect because when the residents seek S1 for assistance or concerns they act in a dismissive manner and does not try to understand the resident concerns. It was also reported that the residents right to live in a normal manner i.e., eating in a communal setting such as, the kitchen or dining room is not allowed by husband and wife Licensees, and that when there are licensee family functions/celebrations Licensees tell the residents (with the exception of 1) to stay in their rooms. The resident rooms are located in a separate wing area of the home that has 2 hallway doors that allow for separation and privacy.

The facility is a licensee operated Adult Residential Facility, in which the residents live in the Licensee's family home. There are only two (2) staff providing care and supervision for the residents. Both Licensee staff denied the allegation. They stated that the majority of the residents have lived in the home for over 20 years and are a part of their family. Staff (S1 & S2) stated the residents are integrated into the family home, and in regards to the residents eating all their meals in their room staff stated that they eat in their room out of choice. The Administrator stated that during the COVID-19 pandemic the residents were eating in their rooms due to social isolation guidelines, and after the pandemic guidelines changed the residents did not want to resume communal dining, and now prefer to eat all their meals in their rooms because all the residents like to watch television while eating. Per Administrator, the facility is following HCBS Final Rule of allowing the residents to choose where and what time they want to eat.

A total of 4 residents were interviewed. All residents denied the allegation, and stated they are treated with respect. However, 2 out of the 4 residents stated that Licensees tell the residents to eat all their meals in their room and stay in their rooms during family parties. Residents reported that there is no space for the residents to eat in the kitchen because the licensee's adult children and grandchildren that reside in the home are eating in the kitchen and dining table areas. All residents reported that they love to watch TV while eating. The kitchen and dining room areas do not have a TV in the room. One (1) family member was interviewed and they had no concerns regarding the treatment of residents. Regional Center staff was interviewed and it was stated that they have observed the facility operations are separated from the family residence because the residents do not enter from the main entrance door and are usually in their room all day. However, based on record review and interviews conducted, there is insufficient evidence to corroborate the allegation.

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

Exit interview conducted with Administrator Guadalupe Sahagun. 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: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC9099 (FAS) - (06/04)
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