197802313-2-13-2024-28-AS-FFIS-D3JQVN-20240320123035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802313
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:52:03 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
02/05/2024 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20240205143121

FACILITY NAME:	ANGELINA HOME AND CARE II		FACILITY NUMBER:	197802313
ADMINISTRATOR:	ESGUERRA, ADELINA		FACILITY TYPE:	735
ADDRESS:	622 N. WATERBURY AVENUE		TELEPHONE:	(626) 257-3245
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	6	CENSUS: 4	DATE:	02/13/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Staff#1, caregiver		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not allow residents to use the facility telephone .
Staff do not provide residents with personal care items.
Staff do not ensure that residents' dietary needs are met.
Staff yells at residents.
Staff speaks inappropriately to residents.
Staff do not allow resident to have possession of their personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation visit for the allegations listed above. During today’s visit, LPA met with staff#1. LPA spoke with staff#2 (S2) House manager, Shirley Esguerra, over the phone during the visit. LPA explained the purpose of today's visit to S1 and S2.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #2 (S2); interviews of clients from Client#1 (C1) through Client #4 (C4); reviewed client#1’s record reviews, and a facility tour. LPA obtained copies of the Staff and client Rosters; and client files for Client #1 (C1) with relevant information.

The investigation revealed the following:

(-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

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-20240205143121

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: ANGELINA HOME AND CARE II	FACILITY NUMBER: 197802313
	VISIT DATE: 02/13/2024

NARRATIVE

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In regard to allegation: staff do not allow residents to use the facility telephone, it was alleged that client was not allowed using the facility telephone to make phone calls. Per client interviews, one (1) out of four (4) clients stated staff did not allow client to use facility phone. Three (3) out of four (4) clients could not corroborate the allegation. Client interview revealed that clients could use facility phone to make phone calls. Per staff interviews, two (2) out of two (2) staff denied the allegation. Staff interviews revealed that facility phone was available for all clients' use. LPA observed that clients were allowed to use facility phone to make calls. Thus, clients were allowed to use facility telephone.

In regard to allegation: staff do not provide residents with personal care items, it was alleged that staff did not provide clients with toilet paper or soap. Per client interviews, one (1) out of four (4) clients stated there were no toilet paper or soap provided at the facility. Three (3) out of four (4) clients could not corroborate the allegation. Client interview revealed that clients were provided with toilet papers / soaps and had no restriction on using them. Client who purchased client's own hygiene supply due to personal preference. Per staff interviews, all staff denied the allegation. Staff interview revealed staff would provide clients with toilet papers and soaps all time. Additional hygiene supplies would provide to clients when needed. LPA observed that clients’ bathroom had toilet paper/soaps in the bathroom. Additional toilet papers, soaps and hygiene supplies were observed and available for clients’ use.

In regard to allegation: staff do not ensure that residents' dietary needs are met, it was alleged that staff did not serve clients with snacks between meals. Per client interviews, one (1) out of four (4) clients stated there were no snacks provided to clients during the day. Three (3) out of four (4) clients could not corroborate the allegation. Client interview revealed that clients had snacks between meals. Per staff interviews, all staff denied the allegation. Staff interview revealed that staff provide snacks, such as cookies, cakes and juices to clients during the day. Per observation, snacks were provided to clients around 3pm. Snacks included bread, juice, cakes, and cookies. LPA conducted physical plant and reviewed food supplies. LPA observed snacks and beverages, such as cookies, crackers, soda, coffee, fruit juice, and milk. Therefore, snacks were provided to clients to meet their dietary needs.

(-continued in LIC 9099 C-)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240205143121

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: ANGELINA HOME AND CARE II	FACILITY NUMBER: 197802313
	VISIT DATE: 02/13/2024

NARRATIVE

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In regard to allegation: staff yells at residents, it was alleged that staff yelled at clients while in care. One (1) out of four (4) clients stated staff yelled at resident. Three (3) out of four (4) clients could not corroborate the allegation. Client interviews revealed staff may talk loud but not yelled at them. All staff denied the allegation. Staff interview revealed clients had personal right and facility had policy that staff could not yell at clients. Therefore, there was not preponderance of evidence to proof staff yelled at clients.

In regard to allegation: staff speaks inappropriately to residents, it was alleged that staff called clients with inappropriate names. Per client interviews, one (1) out of four (4) clients stated staff called client with inappropriate names. Three (3) out of four (4) clients could not corroborate the allegation. Client interviews revealed staff did not speak inappropriately to clients. All staff denied the allegation. Staff interview revealed staff was not allowed to call clients with inappropriate names. Per LPA’s observation during the visit, staff spoke with clients with respect. Therefore, there was not preponderance of evidence to prove staff spoke to clients inappropriately.

In regard to allegation: staff do not allow resident to have possession of their personal belongings, it was alleged that staff confiscated clients’ snacks that client purchased. Per client interviews, one (1) out of four (4) clients stated staff took client’s purchased food but client could not recall any details. Three (3) out of four (4) clients could not corroborate the allegation. Client interviews revealed that clients are able to keep their purchased food and denied of their food being confiscated by staff. Per staff interview, all staff denied the allegation. Staff interview revealed that staff would not allow to confiscate clients’ possession, including food. Thus, there was not preponderance of evidence to prove staff confiscated clients’ possession of their belongings.

Although the allegations 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 allegations are UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with S1. A hard copy of this report was provided to staff.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024

LIC9099 (FAS) - (06/04)

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