197802563-1-19-2024-28-AS-FFIS-D23438-20240201174418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802563
Report Date: 01/19/2024
Date Signed: 01/19/2024 04:58:51 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
09/28/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220928154009

FACILITY NAME:	EL DESCANSO RETIREMENT HOME		FACILITY NUMBER:	197802563
ADMINISTRATOR:	BOUSHERI, CLEMENCIA		FACILITY TYPE:	740
ADDRESS:	21020 E. CIENEGA AVENUE		TELEPHONE:	(626) 967-2868
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	15	CENSUS: 14	DATE:	01/19/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Alberto Galvan, administrator assistant		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff sexually assaulted resident while in care.
Staff inappropriately handled resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced visit to continue the investigation and deliver the complaint finding of the allegations at the facility today. LPA explained the purpose of today's visit to Alberto Galvan, administrator assistant, who assisted with this visit.

On 09/29/22, LPA Tao conducted the initial unannounced investigation at the facility. LPA met with Clemencia Bousheri, Administrator during the visit. LPA conducted a Health and Safety check at the facility and obtained resident#1’ records.

On 10/13/22, a subsequent visit was conducted by Investigator Brian Slatic for an investigation. Investigator interviewed administrator, resident#1 (R1), resident#1’s responsible party, and Ombudsman. IB reviewed R1’s facility file and related documentation.

(- continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

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-20220928154009

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: EL DESCANSO RETIREMENT HOME	FACILITY NUMBER: 197802563
	VISIT DATE: 01/19/2024

NARRATIVE

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In regard of allegation of staff sexually assaulted resident while in care, it was alleged that facility staff put their finger in R1’s vagina while they bathed R1 at the facility. The investigation revealed the following.

On 10/13/22, IB investigator conducted interviews with R1, R1’s responsible party, administrator, staff, and ombudsman. Per resident interview, it revealed the R1 was inconsistence with resident’s statements and the allegation. Thus, the resident could not corroborate the allegation. Per the interviews of staff and responsible party, all of them denied the allegation. Per record review, R1 had a history of not aligning R1’s understanding with the reality and misunderstanding of what was happening to the resident.

On today’s visit, LPA Tao interviewed staff from staff#2 (S2) to staff#4 (S4). All staff denied the allegation. Per resident interviews from resident #2 (R2) to resident#4 (R4), all residents could not corroborate the allegation. Thus, there was not preponderance of evidence to prove staff sexually assaulted resident while in care.

In regard of allegation of staff inappropriately handled resident while in care, it was alleged that staff grabbed, pushed and hit the resident a few times over the past few months. The investigation revealed the following. The department conducted investigation visits on 10/13/22 and 1/19/24 (today). Per resident interviews, four (4) out of four (4) residents interviewed could not corroborate the allegation. It revealed staff did not mishandle residents while providing care. Per the interviews of staff, ombudsman and responsible party, all six (6) of them denied the allegation. Per record review, R1 had a history of not aligning R1's understanding with the reality and misunderstanding of what was happening to the resident.

Per staff interviews, all staff denied the allegation. Per resident interviews from resident #2 (R2) to resident#4 (R4). All residents interviewed could not corroborate the allegation. Per record review, R1 had a history of having R1’s own interpretation of incidents but not aligned with the reality. Thus, there was not preponderance of evidence to prove staff inappropriately handled resident while in care.

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

An exit interview was conducted with Alberto Galvan, administrator assistant. Findings were discussed. A copy this report was provided at the time of visit.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

LIC9099 (FAS) - (06/04)

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