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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603174
Report Date: 02/08/2024
Date Signed: 02/08/2024 10:52:17 AM

Substantiated


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
01/26/2024 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240126145635
FACILITY NAME:ALVARADO CARE HOMEFACILITY NUMBER:
198603174
ADMINISTRATOR:DUNGCA, ROMMELFACILITY TYPE:
735
ADDRESS:1217 S ALVARADO STREETTELEPHONE:
(562) 505-6484
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:46CENSUS: 40DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
09:17 AM
MET WITH:Doris Elicanal - Case ManagerTIME COMPLETED:
11:06 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure medication is dispensed to residents as prescribed.
Staff speaks to residents in an inappropriate manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analsyt (LPA) Erik Zaragoza conducted a subsequent complaint visit in regards to the allegations listed above. LPA explained the purpose of the visit to Doris Elicanal, Case Manager for the facility, and was granted entrance.

The investigation consisted of the following: During the initial visit, LPAs Erik Zaragoza and Sanjay Vaid obtained copies of the staff and resident roster, reviewed the Medication Administration Records (MARs) for five (5) clients, interviewed Staff #1 - 5 (S1 - S5), and also interviewed Clients #1 - 8 (C1 - C8). During today's visit, LPA Erik Zaragoza delivered the findings of the investigation.

The investigation revealed the following: According to the allegation that "Staff does not ensure medication is dispensed to residents as prescribed", it is alleged that S2 calls the clients once to obtain their medication, and if they do not come the first time then S2 will mark that they refused their medications and does not follow up with the clients to ensure they get their medications.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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 4
Control Number 28-AS-20240126145635
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: ALVARADO CARE HOME
FACILITY NUMBER: 198603174
VISIT DATE: 02/08/2024
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
During interviews with the clients, three (3) out of seven (7) clients interviewed corroborated the allegation that they have had issues with getting their medications dispensed to them. One client interviewed stated that they requested their medications be provided to them in their room due to back pain, however they were told by staff that they needed to come to the medication room otherwise they would be marked as refusing their medications. During interviews with staff, three ) out of five (5) interviewed corroborated that there have been some issues with distributing medications to the residents. One staff interviewed stated that they have observed S2 failing to follow-up with clients in their rooms if they do not come to obtain their medications after initially being called to do so. Another staff member who was interviewed stated that they have noticed if clients do not obtain their medications in the morning, S2 advises staff to distribute their morning medications in the afternoon instead, which is against physician's orders. During review of the medications, LPA observed that three (3) out of five (5) clients had medications that were empty and in need of a refill, which staff stated they were working on obtaining from the pharmacy.

In regards to the allegation that "Staff speaks to residents in an inappropriate manner", it is alleged that S2 has called clients rude names in the past including "stupid" or "idiot" if they do not come to obtain their medications. During interviews with the clients, four (4) out of seven (7) clients state that they have been spoken to in a rude manner at some point by staff in the facility. One client interviewed stated that they have been yelled at by S2 to get out of bed to get their medications. Another client interviewed stated that they have observed S2 speaking to other clients in a rude manner in the past. During interviews with the staff, two (2) out of five (5) interviewed corroborated that they have seen staff speak to clients in an inappropriate manner. One staff interviewed stated that they witnessed S2 yelling at C5 and C6 in the past. Another staff interviewed stated that they also observed S2 shouting at clients previously.

Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 1 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the Case Manager Doris Elicanal.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20240126145635
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: ALVARADO CARE HOME
FACILITY NUMBER: 198603174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2024
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
This regulation is not met as evidenced by:
1
2
3
4
5
6
7
Administrator is to ensure that all clients are accorded dignity and respect in their relationship with staff and others. Administrator is to conduct retraining on personal rights with the staff, and provide the materials and attendees of the training to LPA by the POC due date.
8
9
10
11
12
13
14
Based on interviews, LPA determined that S2 has at various times has shouted at or otherwise been rude to the clients at the facility, which poses a potential health and safety risk.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240126145635
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: ALVARADO CARE HOME
FACILITY NUMBER: 198603174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2024
Section Cited
CCR
80075(b)
1
2
3
4
5
6
7
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This regulation is not met as evidenced by:
1
2
3
4
5
6
7
Administrator is to ensure that all clients are properly assisted with self-administering their medications. Administrator is to conduct retraining on medication administration with the staff, and provide the materials and attendees of the training to LPA by the POC due date.
8
9
10
11
12
13
14
Based on interviews and observation, LPA determined that S2 has provided AM medications to clients in the PM, has not followed up with clients in their rooms to ensure they obtain their medications, and also observed missing medications, which poses an immediate health and safety risk.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4