197803516-7-8-2022-28-AS-WSHO-CGCMHC-20220715093715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803516
Report Date: 07/08/2022
Date Signed: 07/08/2022 11:58:16 AM

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
07/07/2022 and conducted by Evaluator Tony Vasallo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220707144148

FACILITY NAME:	STONEGATE GUEST HOME		FACILITY NUMBER:	197803516
ADMINISTRATOR:	EMELITA ALANGUI		FACILITY TYPE:	740
ADDRESS:	1170 CHISOLM TRAIL DR.		TELEPHONE:	(909) 861-3856
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 5	DATE:	07/08/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Emelita Alangui, Administrator		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff behaved inappropriately in the presence of a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Vasallo conducted a complaint visit to investigate the allegation listed above. LPA met with Administrator, Emelita Alangui and explained the allegation.

The investigation consisted of the following: Interviews were conducted with Administrator, two (2) caregivers and five (5) residents. Staff #1's (S1's) file also reviewed.

The investigation revealed the following: It's alleged S1 attempted to kiss and hug Resident #1's (R1's) hospice nurse in front of R1. R1 was interviewed and indicated he/she gets along with caregivers and has not seen staff act inappropriately. Other residents reported they get along with staff and have never seen S1 act inappropriately. Staff #2 (S2) worked with S1 on the date of the alleged incident (7/6/22) and did not see or hear anything unusual. S2 reported that R1's hospice nurse visits weekly and is always in good spirits. S2 reported that on 7/6/22, prior to leaving the facility S2 had a conversation with the hospice nurse. The hospice nurse was in good spirits and thanked both staff prior to leaving the facility. Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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-20220707144148

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: STONEGATE GUEST HOME	FACILITY NUMBER: 197803516
	VISIT DATE: 07/08/2022

NARRATIVE

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S2 said he/she didn't hear any commotion in R1's room and the hospice nurse did not show any signs of being in distress. Facility decided to terminate S1 and therefore S1 was not present during this investigation. S1's file was reviewed to obtain contact information. The number on file was called 3 times and no answer. There was also no voicemail set up. According to Administrator, S1 was going on vacation out of the country. S1's file revealed his/her previous employer. The previous employer was contacted and indicated S1 never acted inappropriate with residents or other caregivers. The facility was toured and there were no cameras observed. There were no witnesses to the alleged incident and no evidence to prove the incident occurred.

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.

Exit interview held. A copy of the report was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC9099 (FAS) - (06/04)

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