198601672-2-2-2024-28-AS-RORN-D28QG7-20240207110905

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601672
Report Date: 02/02/2024
Date Signed: 02/02/2024 03:02:37 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
01/23/2024 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20240123162718

FACILITY NAME:	CLAREMONT MANOR		FACILITY NUMBER:	198601672
ADMINISTRATOR:	GREG HIRST		FACILITY TYPE:	740
ADDRESS:	650 W. HARRISON AVE.		TELEPHONE:	(909) 626-1227
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	360	CENSUS: 249	DATE:	02/02/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Tanya Madrid		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not provide a safe environment for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced complaint visit to the facility. LPA met with Director of Resident Services, Tanya Madrid who assist with the visit. Reason for the visit was explained.

The investigation consisted of the following: Interviews were conducted with 5 staff members and 10 residents from Residential Living Unit. LPA conducted the tour of the Residential Unit which included the administrative building with the main dining room. LPA obtained residents roster and staff roster.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

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-20240123162718

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: CLAREMONT MANOR	FACILITY NUMBER: 198601672
	VISIT DATE: 02/02/2024

NARRATIVE

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The investigation revealed the following: Staff do not provide a safe environment for residents. It was alleged that residents leave their walkers in the aisles and between tables in the dining room, thus creating safety hazards for other residents and servers.
Interviewed nine (9) residents (R2 - R10) denied the allegation and stated that not seeing any residents leave their walkers in the aisles and between tables in the dining room. There are always staff in the dining room to monitor and ensure that residents walkers not blocking residents or servers way and they can navigate in the aisles and between tables. They stated that they didn't hear any complaints from the residents or staff about this matter. One (1) resident (R1) stated that they do not use the walker, just cane and in the dining room they put cane near the entrance wall. R1 stated they worry about others. R1 stated that staff made some arrangements in the dining room. They rearranged the tables in the dining room and now there are more empty spaces for residents to park their walkers. R1 will bring on Administrator's attention again if there will be any issues about this matter. Interviewed staff stated that there are always enough staff in the dining room to monitor residents. They stated they will ask residents and will move / rearrange walkers ensuring the walkways remain clear. During today's visit, LPA toured the dining room while residents were having lunch and observed the following: Residents walkers were observed parked outside of the dining room, next to the wall (near the dining area). Walkers were observed parked inside the dining area near the entrance wall and near the window wall, away from traffic. Multiple residents were observed having lunch while sitting in their wheelchairs, but this did not present a concern of blocking the walkways as there was ample space for the staff and residents to walk around. There was plenty of space for residents with walkers to navigate through. During today's visit, LPA did not observe walkers or wheelchairs obstructing the walkways inside the dining room and creating safety hazards for the staff and residents.

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.
An exit interview was conducted, and a copy of this report was provided to the Executive Director.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024

LIC9099 (FAS) - (06/04)

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