198603189-12-22-2021-28-AS-MVAO-CB32L7-20220126162904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603189
Report Date: 12/22/2021
Date Signed: 12/22/2021 02:42:15 PM

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
12/14/2021 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211214124825

FACILITY NAME:	MAISON DE FLEURS		FACILITY NUMBER:	198603189
ADMINISTRATOR:	PAGANOS, GEORGE		FACILITY TYPE:	740
ADDRESS:	4918 N SUNFLOWER AVE		TELEPHONE:	(714) 606-1854
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	6	CENSUS: 4	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Alice Tongol, Caregiver		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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1. Smoking is occurring inside of the facility.
2. Resident’s care needs are not being met.
3. Residents are forced to go to bed at an unreasonable hour.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced investigation for the allegations listed above. LPA met with Caregiver staff and explained the purpose of the visit.

The investigation consisted of the following:

LPA Chan obtained a copy of the Resident roster, toured the facility, and interviewed the Co-Administrator, 2 Staff, and 3 Residents’ family members/friend. LPA attempted to interview the 4 Residents but were not successful. Residents were either sleeping or could not answer questions. Another resident is in the hospital and was not interviewed. LPA also reviewed 3 Residents’ files.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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-20211214124825

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: MAISON DE FLEURS	FACILITY NUMBER: 198603189
	VISIT DATE: 12/22/2021

NARRATIVE

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The investigation revealed the following:

Allegation – Smoking is occurring inside of the facility. It is alleged that staff are smoking in the facility with residents that use oxygen. LPA toured the facility and observed 1 resident using oxygen. There was a sign posted at the front door stating, “No Smoking: Oxygen in Use”. According to interviews with Staff, they do not smoke and understand the danger of smoking while oxygen is in use. Per Co-Administrator, staff never smoke in the facility and if they want to smoke, they may do so outside of the facility in the patio area. LPA interviewed 3 Resident’s family members or friend, and all stated there are no cigarette smell or odor nor seen any staff smoking when visiting.

Allegation – Resident’s care needs are not being met. It is alleged that staff are not responsive. The Co-Administrator and Staff interviewed stated they take care of their residents and tend to their needs daily. Staff stated they observe for resident’s behaviors and assist immediately. They check on residents often during the day and at night and change their diapers, feed them, shower them, and administer medications. According to family members interviewed, staff are doing a good job in caring for the residents and are attentive.

Allegation - Residents are forced to go to bed at an unreasonable hour. It is alleged that residents need to go to bed at 5pm. Based on interviews with the Co-Administrator and Staff, residents are not forced to go to bed at 5pm. Dinner is served at 4:30pm and after dinner, residents have a choice to go their rooms or stay in the living room. Some will ask to go to their bedrooms, while some stay outside. Residents’ family members and friend interviewed stated that they visit at different times, sometimes in the evenings, and did not see staff forcing residents to sleep.

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.

An exit interview was conducted with Staff. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

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