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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 01/22/2024
Date Signed: 01/22/2024 03:38:22 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/17/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240117151228
FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 63DATE:
01/22/2024
UNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Cynthia Remogut - CaregiverTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not properly address insect infestation on resident's body or belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erik Zaragoza conducted an unnannounced initial complaint visit to address the allegation listed above. LPA was greeted by Cynthia Remogut, caregiving staff, and administrator Adela Santos and explained the purpose of the visit.

The investigation consisted of the following: During today's visit conducted on 1/22/2024, LPA Erik Zaragoza toured seven (7) rooms of the facility, interviewed Clients #1 - 7 (C1 - C7), and Staff #1 - 4 (S1 - S4). LPA also obtained copies of the facility's client and staff roster, along with an invoice for pest control services rendered on 12/29/2023.

The investigaiton revealed the following: In regards to the allegation that "Staff did not properly address insect infestation on resident's body or bleongings," it is alleged that C1 was discovered with bugs on her clothing, and also contracted head lice upon admission to Pomona Valley Hospital.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/17/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240117151228

FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 63DATE:
01/22/2024
UNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Cynthia Remogut - CaregiverTIME COMPLETED:
03:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure resident was adequately hydrated.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erik Zaragoza conducted an unnannounced initial complaint visit to address the allegation listed above. LPA was greeted by Cynthia Remogut, caregiving staff, and administrator Adela Santos and explained the purpose of the visit.

The investigation consisted of the following: During today's visit conducted on 1/22/2024, LPA Erik Zaragoza toured seven (7) rooms of the facility, interviewed Clients #1 - 7 (C1 - C7), and Staff #1 - 4 (S1 - S4). LPA also obtained copies of the facility's client and staff roster, along with an invoice for pest control services rendered on 12/29/2023.

The investigaiton revealed the following: In regards to the allegation that "Staff did not ensure resident was adequately hydrated", it is alleged that C1 was discovered to have been dehydrated upon their admission to Pomona Valley hospital due to inadequate hydration.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20240117151228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAMILTON VILLA
FACILITY NUMBER: 198600271
VISIT DATE: 01/22/2024
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
During interviews with the clients, zero (0) out of seven (7) corroborated the allegation that the facility is not offering them enough water. C1 explained that they do obtain water during breakfast at the facility, and that water is made available to clients in the form of water jugs that are posted at various locations around the facility. None of the other clients expressed concern about the availability of water in the facility. During interviews with the staff members, none of them corroborated the allegation that the staff do not provide enough water for the clients. All staff indicated they have water jugs around the facility, as well as inside their office area and the medication room if any of the clients request water. During the physical plant tour of the facility, LPA observed there are water jugs in select locations for client to refill their water jugs and cups, and also toured the kitchen during lunchtime and observed that water and juice was available for clients.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are 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 held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20240117151228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAMILTON VILLA
FACILITY NUMBER: 198600271
VISIT DATE: 01/22/2024
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
During interviews with the clients, three (3) out of seven (7) interviewed claimed that they have discovered bugs on their body during their stay in the facility. C1 explained that upon their hospitalization, the staff Pomona Valley Hospital had to "take bugs out of my hair," and that there were some bugs on their clothing. Another client interviewed explained that they believe they have been bitten by bedbugs in their room, and showed LPA bug bite marks on their abdomen and shoulders. A separate client interviewed stated that they picked bugs out of their clothes three (3) days prior. Other clients interviewed stated that while they have not found bugs on their body, they have seen roaches and mice within the facility. During interviews with the staff, none of them corroborated the allegation that they did not properly address an insect infestation on resident's body. One staff member interviewed explained that they were not aware of any insect infestation on any of the clients, that the facility receives pest control services once or twice per month, and that if they become aware of an insect infestation on a client they will immediately refer them to their physician in order to get appropriate medication. Another staff member interviewed stated that the facility also provides haircuts for the clients, and always makes sure to check for lice when they are conducted. During the physical plant walk through, LPA observed that there were multiple dead mice caught in traps in the hallways of the resident living quarters.

Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 1 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the administrator Adela Santos.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20240117151228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAMILTON VILLA
FACILITY NUMBER: 198600271
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/23/2024
Section Cited
CCR
80087(a)(1)
1
2
3
4
5
6
7
(a) The facility shall be clean, safe, and sanity and in good repair at all times for the safety and well-being of clients, employees, and visitors. (1) The Licensee shall take measures to keep the facility free of flies and other insects.
This regulation is not met as evidenced by:
1
2
3
4
5
6
7
Administrator is to ensure that the facility remain free of lice and other insects. Administrator will submit a plan to LPA explaining how she will ensure that the facility is free of lice, bedbugs, and other insects by POC due date.
8
9
10
11
12
13
14
Based on interview and observation, LPA determined that C1 contracted head lice while in care, had bugs on their clothing and body, and additionally that other clients have had bug bites on their person as well, which poses an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5