198602564-7-23-2020-28-AS-RORN-BURSS5-20201026140716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602564
Report Date: 07/21/2020
Date Signed: 07/23/2020 10:49:19 AM

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
03/10/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200310164010

FACILITY NAME:	ROYAL VISTA SAN GABRIEL		FACILITY NUMBER:	198602564
ADMINISTRATOR:	FUENTES, SUSANA		FACILITY TYPE:	740
ADDRESS:	901 W SANTA ANITA ST		TELEPHONE:	(626) 289-8889
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91776
CAPACITY:	100	CENSUS: 79	DATE:	07/21/2020
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Susana Fuentes		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff slaps residents in care.
Staff yell at residents in care.
Staff are utilizing unsanitary food service procedures.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez initiated a telephonic subsequent complaint investigation to deliver investigation findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Susana Fuentes.

Investigation consisted of the following: During the initial telephonic visit conducted on 3/20/20, LPA Gonzalez received a copy of Staff and Resident Rosters by email and interviewed Administrator Susana Fuentes. On 5/5/20, LPA Mary Flores conducted a telephone interviews with Residents 1-7 (R1-7), Caregivers Maria Perez, Page Lanyania and Angelica Polanca. LPA Flores also interviewed Kitchen staff: Daisy Lopez and Eugenio Alidio. On 6/11/20, LPA Flores requested the following documents: Face Sheets, Physician’s Report, Needs and Services Plan for R1-7.

(See LIC 9099C for continuation of report)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

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-20200310164010

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: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
	VISIT DATE: 07/21/2020

NARRATIVE

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The investigation revealed the following: In regard to allegations, Staff slaps residents in care and Staff yell at residents in care, it is alleged that a staff working at the facility slap residents in their hands when the residents sit at the dining room table and staff yell at the residents aggressively when residents reach for utensils. Interviews conducted with R1-7 revealed that they are satisfied with the facility staff and their interactions with staff. Interviews conducted with 6 out of 7 residents stated that staff are helpful, nice, and staff seem to enjoy their job and residents did not state any concerns regarding their interactions with facility staff. R3 was unable to answer interview questions due to cognitive challenges. Interview conducted with Administrator Fuentes revealed that staff treat all residents with dignity and respect and administrator denied that any staff at the facility yell or slap residents on their hands. Administrator sated that facility residents are very outspoken and they come to her with any concerns they have regarding the staff or facility and she has never heard such allegations from any resident at the facility. Staff interviews conducted on 5/5/20 by LPA Flores revealed that staff consider having good relationships with facility residents and staff stated that they are aware that if they observe or know of any instances of residents being mistreated or their personal rights being violated they know that they are mandated reporters and are aware of mandated reporting requirements. Based on LPAs interviews conducted with facility staff and residents and LPAs review of staff training records, there was not enough supportive evidence to concur with the reported allegation.

For the allegation, Staff are utilizing unsanitary food service procedures, it is alleged that meat that is served to residents is undercooked and is served raw. It is also alleged that a facility cook was sick and facility cook did not wear a mask or gloves, coughed and sneezed while preparing the food and the cook's fingers kept going into the soup while the staff was passing out soup to the residents. Interview with facility administrator revealed that all kitchen staff wear gloves at all times while preparing the food and also when they distribute the food. Administrator stated that all staff are now mandated to wear a mask and that kitchen staff wear a mask at all times also. Administrator stated that all staff are properly trained and since the facility is being more cautious due to COVID-19 all staff including kitchen staff are wearing masks and gloves at all times. Administrator stated that she has not received any complaints from any resident reporting that servers are serving food without gloves or that their fingers are going into their food as it is being passed out. Interviews with 2 out of 7 residents revealed that food servers use gloves when serving food. 4 out of 7 residents said that kitchen staff use a mask. Staff interviews conducted on 5/5/20 by LPA Flores revealed that staff use face masks since the beginning of March 2020 and kitchen staff have always used gloves while preparing food and also while serving food to residents. LPAs review of staff training revealed that staff

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20200310164010

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: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
	VISIT DATE: 07/21/2020

NARRATIVE

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working in the kitchen have completed 40 hours of training on Proper Food Handling. Based on LPAs interviews conducted with facility staff and residents and LPAs review of staff training records, there was not enough supportive evidence to concur with the reported allegation.

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. A copy of the report was provided to Administrator Susana Fuentes.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2020

LIC9099 (FAS) - (06/04)

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