<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801459
Report Date: 04/08/2025
Date Signed: 04/08/2025 05:08:34 PM

Substantiated


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
01/03/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250103090926
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:
04/08/2025
UNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Guadalupe SahagunTIME COMPLETED:
05:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is in disrepair.
Facility failed to update plan of operation.
Staff did not meet client's needs.
Staff did not meet training requirements.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation regarding the allegations 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. Food supply and window screen was checked. Staff (S1-S2) and residents (R1-R4) were interviewed. Resident (R1 & R2's) file documents and plan of operation were reviewed. Relevant copies were obtained.

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

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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 6
Control Number 28-AS-20250103090926
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: 04/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Facility is in disrepair. The complaint alleges that on 12/17/2024 a bedroom window screen was observed bent and the glass in the bathroom vent was broken. Administrator stated daughter's kids room window screen was in disrepair and a bathroom vent glass part was missing. All four (4) residents were interviewed, none reported knowledge of dis-repairs. On 1/10/2025, LPA confirmed the aforementioned disrepair of window screen and missing bathroom vent. Pictures were taken. Therefore, there is sufficient evidence to corroborate the allegation.

Allegation: Facility failed to update plan of operation. It is alleged Licensee did not update the facility plan of operation i.e., surveillance cameras were installed in the exterior perimeter area, there are two dogs, and Licensee's adult child and their two children are residing in the home. Licensees stated the plan of operation/program design does not specifically state the facility is owner operated with children and pets in the home. Staff interviews revealed that outdoor surveillance cameras were installed in early 2024. Resident interviews confirmed there are dogs and children living in the facility. Based on record review of approved plan of operation, the findings indicate changes to the plan of operation i.e. licensee daughter and kids, two household dogs, and installation of outdoor surveillance cameras were not reported to CCLD or the Regional Center. Therefore, there is evidence to support the allegation.

Allegation: Staff did not meet client's needs. The complaint alleges that resident (R1 &R2) did not have file documentation of R1's prostate exam and R2's gynecological exam records. Staff and residents were interviewed. The findings indicate that residents are taken to annual physician appointments where prostate and gynecological exams are recommended and/or performed. In R1's case, the resident stated they refuse to have a regular prostate exam, but their physician checks blood work for prostate issues. Resident (R2) stated their sister takes them to gynecological exams. Administrator stated the exams are conducted, but physician documentation was not obtained or filed, and there is no section on the Physician's Report that specifically addresses a prostate or gynecological exam. Based on record review, Licensee/Administrator obtained proof of exams after the Regional Center issued a Corrective Action Plan (CAP).

Allegation: Staff did not meet training requirements. The complaint alleges staff (S2) had not completed 8 hours of required annual CEU training from an accredited institution or professional. Staff (S2) stated they did not have the CEU training. Administrator stated monthly training is conducted, but they did not know the 8 hours of CEU training had to be conducted by an outside source. Based on record review, the findings indicate staff (S2) did not meet the 8-hour CEU training requirements.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are cited according to Title 22. See LIC 9099D. Exit interview was conducted with Guadalupe Sahagun. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20250103090926
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2025
Section Cited
CCR
80088(b)
1
2
3
4
5
6
7
Furniture, Fixtures, Equipment, and Supplies. All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement was not met evidenced by:
1
2
3
4
5
6
7
Administrator stated the repairs were corrected January 2025. LPA observed that window screen in bedroom and bathroom glass pane has been repaired.

***Cleared during the visit.
8
9
10
11
12
13
14
Based on observation during initial visit (1/10/25), the findings indicate a bedroom had a window screen that was bent and the bathroo window glass was missing. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
04/29/2025
Section Cited
CCR
80022(j)
1
2
3
4
5
6
7
Plan of Operation. Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061.

This requirement was not met evidenced by:
1
2
3
4
5
6
7
Administrator agreed to submit an amendment to the plan of operation that states there are additional family members i.e., children residing in the home, as well as 2 dogs, and surveillance cameras have been installed.
Submit an updated facility sketch that specifies which rooms are designated for residents, family, and location of cameras.
8
9
10
11
12
13
14
Based on interviews and plan of operation review, the facility is licensee operated, but the plan does not specify that licensee's children or grandchildren live in the home, or that there are 2 dogs, and surveillance cameras in the exterior of the facility. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20250103090926
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2025
Section Cited
CCR
80069(d)(3)
1
2
3
4
5
6
7
Client Medical Assessment. In addition to Section 80069(c), the medical assessment for clients in ARFs shall include the following: (3) Documentation of prior medical services and history.

This requirement was not met evidenced by:
1
2
3
4
5
6
7
Administrator provided a copy from R1's physician stating that the resident was screened for prostate cancer. Resident (R2's) gynecological exam report (1/10/25) was obtained.

**Cleared during the visit.
8
9
10
11
12
13
14
Based on record review, R1 & R2's files did not have medical history on prostate and gynecological exams, although both residents' physician's had completed the exam files were missing documentation. This poses a potential health, safety, and personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
04/08/2025
Section Cited
CCR
80022(b)(6)
1
2
3
4
5
6
7
Plan of Operation. The plan and related materials shall contain the following: Plan for inservice education of staff if required by regulations governing the specific facility category.

This requirement was not met evidenced by:
1
2
3
4
5
6
7
Administrator/Licensee agrees to ensure staff (S2) and any other staff complete annual required 8-hour CEU training.

**Cleared during the visit. Administrator provided proof that on 2/4/25, S2 completed 8 CEU training hours.
8
9
10
11
12
13
14
Based on record review, staff (S2's) file only had in-house monthly training, but not CEU training conducted by an accredited institution or professional. This poses a potential health, safety, and personal rights risks to persons in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
01/03/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250103090926

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:
04/08/2025
UNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Guadalupe SahagunTIME COMPLETED:
05:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to follow dietary needs.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation regarding the allegations 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. Food supply and window screen was checked. Staff (S1-S2) and residents (R1-R4) were interviewed. Resident (R1 & R2's) file documents and plan of operation were reviewed. Relevant copies were obtained.

**See 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: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20250103090926
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: 04/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff failed to follow dietary needs. According to information obtained resident (R1's) special diet is not being followed. It is alleged that R1 requires a low sodium and 1,800 calories per day diet, but Licensee/Administrator is not preparing special diet food for the resident. Administrator stated that R1 moved to the facility in 2014 and documents received did not include dietary restrictions, and per most recent doctor visit [1/21/2025] the resident continues to be on a regular diet. Ms. Sahagun stated that in the past Regional Center Service Coordinators were informed that the IPP reports did not have updated physician information on dietary restrictions. A total of 4 residents were interviewed. Resident (R1) stated that they have not been on any dietary restrictive diets in years, and when they moved to the facility they already were on a regular diet. Residents and staff stated they are not on restrictive diets. Based on record review, 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 violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted and a copy of this report was discussed and provided to facility Administrator Guadalupe Sahagun.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6