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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600654
Report Date: 08/05/2024
Date Signed: 08/05/2024 01:57:11 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
07/31/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240731151941
FACILITY NAME:CONTINENTAL GUEST HOMEFACILITY NUMBER:
198600654
ADMINISTRATOR:RUBERTO BALUYOTFACILITY TYPE:
735
ADDRESS:15482 PASTRANA DRIVETELEPHONE:
(714) 522-3013
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:4CENSUS: 4DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Corazon Casanas - Direct Support StaffTIME COMPLETED:
02:13 PM
ALLEGATION(S):
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Facility staff mismanaged client's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Corazon Casanas and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/client roster. LPA reviewed medication for (4) clients and observed (4) clients’ bedrooms. LPA requested copies of medication sheets for the month of July and August 2024, physician’s reports, individual program plan, admission agreement, house rules, face sheet, notes for client #1, and #2 (C1-C2), and medications sheets from January 2024 – June 2024 for C2. LPA interviewed 3 staff and 2 clients.

The investigation revealed the following: Regarding allegation: Facility staff mismanaged client’s medication. It is alleged medication was not in bubble packs for the afternoon dose, staff was not able to find the medication, staff initialed medication sheet in advance, and PRN medication was not logged correctly.
(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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
Control Number 28-AS-20240731151941
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: CONTINENTAL GUEST HOME
FACILITY NUMBER: 198600654
VISIT DATE: 08/05/2024
NARRATIVE
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Interview with administrator revealed that staff have had issues with logging medication provided to clients in the medication sheets including PRN medications provided. Medication training has been provided by the administrator to staff on 7/23/24. Interviews with clients revealed they have received their medication timely. Medication review revealed each medication sheet was marked for today’s date medication provided in the morning and the medication matched the medication sheets for the month of August for each client. LPA observed a PRN medication was provided to client #3(C3) on 7/3/24 and the pill was still on the bubble with the date next to it. However, a pill was missing and had no date noted next to it, staff noted in the back of the medication sheet medication was provided on 7/3/24. LPA observed PRN medication for C2 was given between 1/30/24 and 7/29/24 per bubble pack and reviewed medication sheets from January to August 2024, LPA notice discrepancies on logging medication provided to C2 between January 2024 to June 2024.

Based on LPAs observations, interviews which were conducted, and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview was conducted and a copy of this report, LIC 9099D, and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20240731151941
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: CONTINENTAL GUEST HOME
FACILITY NUMBER: 198600654
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2024
Section Cited
CCR
80075(b)(5)(C)
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 Health Related Services : (b) Clients shall ... (5)... need for nonprescription PRN medication,... (C) A record of each dose is maintained...The record shall include the date and time the PRN medication was taken, the dosage taken, and the client's response. This requirement is not met as evidence by:
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Administrator will provide training to staff from a health professional regarding recording dosage given, dates, and response, and will submit a copy of this training to the department by POC due date 8/12/24.
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Based on interviews and documents review licensee did not ensure PRN medication was being recorded correctly for C2 and C3 which poses a potential health, safety, or personal rights to the persons in care.
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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 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
07/31/2024 and conducted by Evaluator Mary G Flores
COMPLAINT CONTROL NUMBER: 28-AS-20240731151941

FACILITY NAME:CONTINENTAL GUEST HOMEFACILITY NUMBER:
198600654
ADMINISTRATOR:RUBERTO BALUYOTFACILITY TYPE:
735
ADDRESS:15482 PASTRANA DRIVETELEPHONE:
(714) 522-3013
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:4CENSUS: 4DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Corazon Casanas - Direct Support StaffTIME COMPLETED:
02:13 PM
ALLEGATION(S):
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Client's clothing is inaccessible to client
Client's admission agreement is not being adhered to
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Corazon Casanas and explained the reason for the visit.

The investigation consisted of the following: LPA requested a copy of staff/client roster. LPA reviewed medication for (4) clients and observed (4) clients’ bedrooms. LPA requested copies of medication sheets for the month of July and August 2024, physician’s reports, individual program plan, admission agreement, house rules, face sheet, notes for client #1, and #2 (C1-C2), and medications sheets from January 2024 – June 2024 for C2. LPA interviewed 3 staff and 2 clients.

The investigation revealed the following: Regarding allegation: Client’s clothing is inaccessible to the client. It is alleged C1 has a tendency to destroy or remove clothes. Therefore, cabinets have been placed facing the wall making them inaccessible to the client.
(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20240731151941
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: CONTINENTAL GUEST HOME
FACILITY NUMBER: 198600654
VISIT DATE: 08/05/2024
NARRATIVE
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Interviews with staff revealed that C2 began to put dirty diapers inside the clean clothes drawers some months ago and throwing the clothes in the floor some weeks ago. Staff to prevent client placing dirty items inside the drawers decided to turn the dresser to face the wall. However, staff allow the clients to choose what they will wear each day as they are assisting with activities of daily living throughout the day. Administrator stated that after the Regional Center visit and provided violations regarding the above, has contacted the Regional Center service coordinator for guidance. Service Coordinator will hold a meeting on August 14th and will discuss then how to best assist with the behaviors. Interviews with clients revealed the clients have access and choice to what they will wear each day and have no concerns regarding accessing their personal belongings. During facility’s tour, LPA observed C1 and C2 shared bedroom and their clothes is hanging in the closet as well as their clothes placed in the drawers of each client’s dressers facing forward.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Client’s admission agreement is not being adhere to. It is alleged the facility is not following the HCBS final ruling for access to personal belongings. Interviews conducted with administrator revealed facility is adjusting to the new HCBS final ruling and is to provide training to staff regarding HCBS final ruling. Staff were able to identify personal rights regarding items clients may choose to wear and other client's personal rights. Interviews with clients revealed they are able to choose and have access to the items they choose. Documents reviewed revealed C2 showed behavior of placing worn underwear in clean clothes drawers starting 3/16/24. On 4/20/24 C2 place a dirty adult brief either inside the closet, cabinet and mixing it with the clean clothes. Therefore, staff chose to turn the dresses to prevent dirty items going into the clean clothes. Per IPP both C1 and C2 need assistance with daily living activities, including getting dress daily. No modifications have been done to the IPP regarding the current behaviors.Even though, facility staff was preventive client from accessing the dresser drawers, staff was also preventing client from placing dirty items within the clean items and ensuring the behavior did not compromise the health and safety of the clients.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5