198601976-3-28-2024-28-AS-RORN-D4MMP7-20240424094641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601976
Report Date: 03/28/2024
Date Signed: 03/28/2024 02:48:48 PM

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
03/19/2024 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240319134029

FACILITY NAME:	DEL MAR PARK		FACILITY NUMBER:	198601976
ADMINISTRATOR:	DENISE SUTTON		FACILITY TYPE:	740
ADDRESS:	990 EAST DEL MAR BOULEVARD		TELEPHONE:	(626) 577-0215
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	60	CENSUS: 53	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Denise Sutton		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Denise Sutton and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Administrator Denise Sutton, Staff 1-5 (S1-5) and Residents 1-5 (R1-5). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file. LPA collected copies of documents pertinent to the complaint investigation. LPA conducted a tour of the facility inside and out which consisted of inspection and observations of the lobby, and (5) five resident rooms. LPA conducted a phone call with R1's Family Member (C1 FM).

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20240319134029

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: DEL MAR PARK	FACILITY NUMBER: 198601976
	VISIT DATE: 03/28/2024

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff handled resident in a rough manner, it is alleged that on 03/15/24, a facility staff (S1) handled a facility resident (R1) in a rough manner. R1 was allegedly having Physical Therapy when S1 poked them in the chest as a form of motivation. Interview with facility administrator revealed that R1 called the police department and reported that S1 handled them in a rough manner. Administrator stated that R1 does not have physical therapy and stated that S1 or any other staff have not handled R1 or any other resident in a rough manner. Administrator stated that R1 has some confusion. She stated that R1 does require assistance with their Activities of Daily Living (ADLs) and has not previously reported any concerns about any staff handling them in a rough manner before reporting this alleged incident. Interviews conducted with 5 out of 6 staff revealed that facility staff do not handle R1 or any other resident in a rough manner. They stated that they provide care to residents which includes assistance with their ADLs. 1 staff stated that they have heard that a staff at the facility (S5) handles residents roughly and is aggressive with some residents when turning them. S5 denied ever handling any resident in a rough manner and denied ever treating any resident aggressively. Interviews with facility staff revealed that facility residents are always treated with dignity and respect. Interviews conducted with 4 out of 5 residents revealed that facility staff have never handled them in a rough manner, they are satisfied with the services and do not have any concerns. 1 resident stated that a staff at the facility poked them in the chest area but it did not cause any bruising. They stated that they do not remember if it was a male staff or a female staff. They stated that it has not happened again. C1 FM stated that they are satisfied with the services R1 is getting at the facility and does not have any concerns. C1 FM stated that R1 did report to them that an incident had occurred on 03/15/24 but was not able to provide details to them about the incident. C1 FM stated that R1 does have some confusion. LPA reviewed of R1's Physician's Report for Residential Care Facilities for the Elderly (RCFE) dated 12/01/23 which revealed that R1 is diagnosed with Major Neurocognitive Disorder and has conditions and behaviors in relation to that diagnosis. R1 requires assistance with their ADLs. LPA observed interactions between staff and residents and did not observe anything of concern. LPA additionally did not observe any bruising on any resident. Based on statements gathered from interviews conducted with staff, residents, C1 FM and LPA record review and observations there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Administrator Denise Sutton.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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