<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602596
Report Date: 08/16/2023
Date Signed: 08/16/2023 02:04:11 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
01/03/2022 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220103103433
FACILITY NAME:JASWILL BROOKMILLFACILITY NUMBER:
198602596
ADMINISTRATOR:CRUZ, JASFERFACILITY TYPE:
735
ADDRESS:7822 BROOKMILL RDTELEPHONE:
(562) 381-0242
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:4CENSUS: 3DATE:
08/16/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Jasfer Cruz (AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not following CDC guidelines for infection control.
Staff are not following doctor's orders.
Staff are not meeting residents incontinence needs.
Staff do not keep resident's room sanitary.
Staff do not prevent secondhand smoke from entering into the facility.
Staff are not providing resident with sanitary food.
Staff are not providing residents with individual utensils.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kruz Long conducted a subsequent complaint visit at the facility. Upon arrival, LPA met with Jasfer Cruz (Administrator) and explained the purpose of the visit.

During the initial visit on 01/10/22, LPA obtained and reviewed a copy of the Staff and Client Roster.

During today's visit, LPA obtained a copy of the Staff/Client rosters and Client #2's physician's order, toured the facility with Staff #1, interviewed Staff #1 to #3 in the dining area, interviewed Client #1 in the bedroom and attempted to interview Clients #2 to #3.

Regarding allegation: Staff are not following CDC guidelines for infection control. Per allegation details, it was alleged that the facility is not disinfecting/cleaning the facility based on CDC guidelines. LPA toured the entire facility and observed the facility to be clean and in good repair. Interviews with 3 of 3 Staff indicate the facility is cleaned or disinfected every shift. Interview with 1 of 1 Client indicate the facility is always clean and Staff cleans the facility at least 3 times a day. Continue to LIC9099C......
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20220103103433
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: JASWILL BROOKMILL
FACILITY NUMBER: 198602596
VISIT DATE: 08/16/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding allegation: Staff are not following doctor's orders. Per allegation details, Staff is not putting on a helmet for Client #2 upon getting up from the wheelchair. LPA obtained a copy of the doctor's order which does not specify a helmet is require to be put on Client #2 when getting up from the wheelchair. Interviews with 3 of 3 Staff indicate a helmet is provided to Client #2 during day program and other activities for safety measures but Client #2 may refuse it. Interview with 1 of 1 Client also indicate Staff is providing a helmet for Client #2.

Regarding allegation: Staff are not meeting residents incontinence needs. Interviews with 3 of 3 Staff indicate Clients with incontinence needs are check every hour and assisted with diaper changes. Interview with 1 of 1 Client also indicate Staff checks on Clients every hour and provide diaper changes if needed.

Regarding allegation: Staff do not keep resident's room sanitary. It was alleged that Staff places a urinal/container in Client #1's bedroom and does not clean the urinal/container out for an extended period of time. LPA toured the facility and did not observe a urinal/container in Client #1's bedroom. Interview with Client #1 indicated that a urinal/container was never placed in the bedroom. Interviews with 3 of 3 Staff also indicate a urinal/container was never placed in Client #1's bedroom or any other bedrooms.

Regarding allegation: Staff do not prevent secondhand smoke from entering into the facility. Interviews with 3 of 3 Staff indicate neither Staff or Clients smoke. Interview 1 of 1 Client also indicate that Staff and Clients do not smoke.

Regarding allegation: Staff are not providing resident with sanitary food. LPA toured the kitchen and food storage area and observe foods to be sanitary and of good quality. Interviews with 3 of 3 Staff indicate food is sanitary. Interview with 1 of 1 Client indicate food is sanitary.

Regarding allegation: Staff are not providing residents with individual utensils. LPA toured the kitchen and observe utensils to be clean and in good repair. Interviews with 3 of 3 Staff indicate Clients have their own utensils and is not shared. Interview with 1 of 1 Client also indicate they are being provided with their own utensils and it is not shared with other Clients.

Based on LPA's observations, record review and interviews, the investigation revealed: Although the allegations may have happened or is 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 conducted with Celia Paglinawan (Caregiver) and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2