198601502-11-21-2024-28-AS-DSIS-DBNW4T-20241205155800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601502
Report Date: 11/21/2024
Date Signed: 11/21/2024 10:43:46 AM

Unsubstantiated

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
10/11/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241011082314

FACILITY NAME:	RAYMOND HOUSE		FACILITY NUMBER:	198601502
ADMINISTRATOR:	HAMILTON, DAVID		FACILITY TYPE:	735
ADDRESS:	872 N RAYMOND AVE		TELEPHONE:	(626) 792-8813
CITY:	PASADENA	STATE: CA	ZIP CODE:	91103
CAPACITY:	22	CENSUS: 11	DATE:	11/21/2024
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Carmelita Bernardo - Caregiver		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff are not treating resident with dignity and respect.
Staff are not properly managing resident's medication.
Staff did not safeguard resident's personal belongings.
Staff are not properly addressing altercations between residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent visit to deliver findings on the above allegations. LPA met with Phillip Jordan (Administrator) and explained the purpose of today's visit.

The investigation consisted of the following:
During the initial visit conducted on 10/15/24 LPA Truman obtained copies of the staff and client rosters, reviewed file for Client #1 (C1), obtained copies of relevant documentation, interviewed Staff #2- Staff #4 (S2 – S4), and interviewed C1.
During subsequent visit conducted on 11/14/24 LPA Herrera obtained copies of the staff and client rosters, reviewed C1's file and obtained copies of relevant documentation, interviewed 4 staff members, and obtained contact phone numbers for other potential interviews. LPA was later able to interview via phone calls 2 clients and the Regional Center Service Coordinator that is assigned to C1.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

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-20241011082314

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: RAYMOND HOUSE	FACILITY NUMBER: 198601502
	VISIT DATE: 11/21/2024

NARRATIVE

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The investigation revealed the following:
Allegation: Staff are not treating resident with dignity and respect.
It is alleged that staff (S2 & S3) have spoken inappropriately to C1 and telling them that they are not a good person and have argued with C1 and their family. LPA attempted to speak with C1, however, C1 is no longer a client at facility and did not answer phone calls. LPA Truman was able to interview C1 during the initial visit on 10/15/24 and C1 stated during interview that S2 and S3 are nice, and have good intentions. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation, stating that C1 can be argumentative and aggressive, however, staff have never been seen, observed or overheard to be that way with C1. LPA attempted interviews with clients, due to cognitive disabilities LPA was only able to conduct 2 successful client interviews, in which both clients denied the above allegation and stated that staff are kind and treat them respectfully. LPA interviewed C1’s regional center service coordinator and they stated that C1 has history of being verbally aggressive with staff and family but have not heard or observed staff being verbally aggressive/argumentative with C1. The service coordinator also confirmed that C1 has not mentioned these alleged incidents during their in person review.

Allegation: Staff are not properly managing resident's medication.
It is alleged that C1 has been forced to take a medication that is not prescribed to them as it is medication for a diagnosis that they do not have. LPA Truman was able to interview C1 during the initial visit on 10/15/24 and C1 revealed that they do not take any medication and have refused medication. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that C1, upon admission, has refused to take medication. This is something that facility staff, service coordinator and family have been attempting to improve, however, there has been no success with medication or doctor visits. LPA reviewed medications and Medication Administration Record and did not observe any issues. LPA reviewed C1’s file and the medication that is allegedly not prescribed to them was listed in both the Physician Report and Regional Center documents. LPA attempted interviews with clients, due to cognitive disabilities LPA was only able to conduct 2 successful client interviews, in which both clients denied the above allegation and stated that staff help with medications and they haven’t experienced any issues with medication. LPA interviewed C1’s regional center service coordinator and they stated that C1 has been non-compliant with medication since before being admitted to facility and they have been trying to work with C1’s family and facility to become medication compliant, with no success as of yet.
(continued on LIC9099-C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20241011082314

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: RAYMOND HOUSE	FACILITY NUMBER: 198601502
	VISIT DATE: 11/21/2024

NARRATIVE

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Allegation: Staff did not safeguard resident's personal belongings.
It is alleged that C1 has both food and personal belongings (a cup) that have been used and consumed by others, and staff did not ensure that their belongings were properly safeguarded. Interview with S1 revealed that C1 had used a cup to drink out of, placed it in the sink, and later another client used it, this made C1 upset and is believed to be the reason for this allegation. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that the cups at the facility are intended for all clients to be able to use and are not reserved for one particular client, additionally staff stated they were unaware that C1 had a personal cup. Staff stated that if a client is to bring outside food the food will be placed in a plastic bag with clients name and date, and placed in the refrigerator. The 4 staff stated that they have not given clients food to other clients. LPA attempted interviews with clients, due to cognitive disabilities LPA was only able to conduct 2 successful client interviews, in which both clients denied the above allegation and stated that they believe their personal belongings are kept safe. LPA interviewed C1’s regional center service coordinator and they stated that C1 has not mentioned any of these claims to them in the conversations they have had.

Allegation: Staff are not properly addressing altercations between residents.
It is alleged that C1 has been spit on and disrespected by other clients and staff did nothing to prevent or address these altercations. Interview with S1 revealed that C1 is more independent than the other clients and recalls a time when one client did speak loudly towards C1, however, it was explained to C1 that the client has an intellectual disability and its their way of communicating, this was the only altercation that S1 was able to recall and is believed to be the reason for this allegation. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that there have not been any altercations between clients at the facility due to their cognitive disabilities. LPA attempted interviews with clients, due to cognitive disabilities LPA was only able to conduct 2 successful client interviews, in which both clients denied the above allegation and stated that they have never been in any altercations with any of their peers or staff. LPA interviewed C1’s regional center service coordinator and they stated that C1 has not mentioned any of these claims to them in the conversations they have had.

Based on statements and interviews conducted, review of C1’s files and medication review, 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: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024

LIC9099 (FAS) - (06/04)

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