198601845-3-5-2024-28-AS-RORN-D3RVL4-20240327163119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601845
Report Date: 03/05/2024
Date Signed: 03/05/2024 11:16:25 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
02/28/2024 and conducted by Evaluator Christine Wong

COMPLAINT CONTROL NUMBER: 28-AS-20240228102102

FACILITY NAME:	A SPLENDOR LIVING - THE GLENDORA INC		FACILITY NUMBER:	198601845
ADMINISTRATOR:	CHRIS JENG		FACILITY TYPE:	740
ADDRESS:	452 SELLERS ST.		TELEPHONE:	(626) 594-0152
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91741
CAPACITY:	34	CENSUS: 8	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Rachel De Chavez		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff physically assaulted resident in care.
Staff are not properly trained to care and supervise residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wong conducted an initial 10 days complaint ” visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with administrator Rachel De Chavez who allowed entry into the facility and explained the reason of the visit and later on the administrator assisted with the visit.

The investigation consisted of the following: LPA interviewed the administrator, two staff (S1 and S2) in the facility and one staff (S3) via telephone and four residents (R1-R4) and R1's daughter via telephone and obtained the copy of documents including: resident and staff roster, R1's Identification and Emergency Infomration, physician report, admission agreement, Needs and Service Plan, resident appraisal, medication list and resident incident reports and S1's training hours and certificate.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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-20240228102102

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: A SPLENDOR LIVING - THE GLENDORA INC	FACILITY NUMBER: 198601845
	VISIT DATE: 03/05/2024

NARRATIVE

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The investigation revealed of the following: Allegation#1 "Staff physically assaulted resident in care. " It's alleged S1 physically assaulted R1 and had swelling on the leg." LPA interviewed four (4) residents and all four residents denied the allegation and stated that no staff physically assaulted them and all staff are outstanding and pleasant and nice to them. They never witnessed any staff hitting any residents or handle the residents roughly. LPA interviewed the staff and all denied the allegation and reported no staff ever physically assaulted on residents or no staff ever handled residents roughly or being mean to residents. The administrator reported the facility did send R1 for a x ray on the leg due to the swelling but it reported nothing and result was negative on fracture.

Allegation#2 "Staff are not properly trained to care and supervise residents in care." It's alleged the staff has been accused of physically assaulted resident and raised concerns about the facility hiring practices and employee training. The administrator reported the facility required staff to have completed training before start working with the residents. LPA reviewed staff files and all staff received the 40 hours RCFE orientation training hours when they first hired and 20 hours training annually and regular in service training and updated first aid certificate.

Based on documents reviewed, interviews conducted with 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 allegations are UNSUBSTANTIATED

An exit interview was conducted with Administrator Rachel De Chavez and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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