198601815-12-8-2022-28-AS-MVAO-CMHV9M-20221227151434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601815
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:32:29 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
06/18/2020 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200618132419

FACILITY NAME:	ALFORD HOME		FACILITY NUMBER:	198601815
ADMINISTRATOR:	SEAN ESTRELLA		FACILITY TYPE:	734
ADDRESS:	165 ALFORD ST		TELEPHONE:	(909) 599-7403
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	5	CENSUS: 4	DATE:	12/08/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Efnan Scott		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff did not call 911 in a timely manner thus jeopardizing client’s health
Staff training is insufficient to recognize when to contact 911

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Efnan Scott and explained the reason for the visit.
The purpose of the visit is to deliver the findings from the original complaint dated 06/18/2020.
An initial Health and Safety check visit was conducted on 06/24/2020.
An investigation was conducted by the Investigations Branch (IB) from the Department of Social Services and completed 10/06/2020 and included the following:
Obtaining and reviewing documents from the facility, documentation from San Gabriel Pomona Regional Center and interview with San Gabriel Pomona Regional Center representative, interviews with facility staff members, medical records, and 911 written report and audio review.
In regards to the allegation Staff did not call 911 in a timely manner thus jeopardizing client’s health, it was revealed in interview with representative from San Gabriel Pomona Regional Center who denied that he found any abuse and or neglect/lack of supervision and care. Stated that Resident R1 was seen with a change in condition and the staff on duty were not neglectful, but did everything they could and were responsive

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

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-20200618132419

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: ALFORD HOME	FACILITY NUMBER: 198601815
	VISIT DATE: 12/08/2022

NARRATIVE

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relative to providing care, supervision and providing nursing interventions to improve R1's O2 saturation levels.
Based on interviews conducted and information gathered it was revealed that R1 needed constant care which included monitoring O2 saturation levels.
Staff interviews revealed that if O2 saturation levels were low and R1 had trouble breathing constant supervision, care, assessment and nursing interventions were implemented in order to improve R1's O2 level.
File review revealed that between 05/02/2020 through 05/14/2020, but also on 05/19/2020. 05/24,2020, and 05/25/2020 revealed that R1 had a decrease in O2 saturation levels with bouts of coughing and nursing interventions were given during the above dates and were reported as condition was improved.
Licensed Vocational Nurse (LVN) stated that R1 was not in medical or emergent distress when providing nursing interventions. It was normal for R1's oxygen levels to drop and then show improvements through nursing interventions, Stated that in the past nursing interventions helped to decrease labored breathing and respiration which improved O2 levels.
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.
In regards to the allegation Staff training is insufficient to recognize when to contact 911, review of documentation revealed that staff on duty with R1 had completed the following trainings:
Year 1 and 2 Direct Support Professional Training Class, and Heart Saver First Aid.
Based on interviews conducted and information gathered the Direct Support Professional (DSP) and Licensed Vocational Nurse (LVN) on numerous occasions assisted R1 when there were low O2 saturation levels and would implement the same nursing interventions to stabilize R1.
Interview with San Gabriel Pomona Regional Center Representative who stated that Resident R1 was seen with a change in condition and the staff on duty were not neglectful, but did everything they could and were responsive relative to providing care, supervision and providing nursing interventions to improve R1's O2 saturation levels.
Staff interviewed stated that typical nursing interventions were implemented when O2 levels were low and on numerous occurrences would check vitals, reposition to a 90 degree angle and provide breathing treatments.
Staff interviewed stated that at no point was R1 in any unusual or high distress and if there were 911 would be called.
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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2022

LIC9099 (FAS) - (06/04)

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