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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603273
Report Date: 06/01/2023
Date Signed: 06/01/2023 04:03:59 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
11/19/2021 and conducted by Evaluator Joe Katrdzhyan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211119074345
FACILITY NAME:BRADBOURNEFACILITY NUMBER:
198603273
ADMINISTRATOR:SMITH, JAYFACILITY TYPE:
735
ADDRESS:1332 BRADBOURNETELEPHONE:
(855) 302-3331
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:4CENSUS: 3DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Staff / Terry Jelk
Assistant Administrator / Joey Perez
TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Resident sustained unexplained injuries while in care

Staff did not seek medical attention for resident in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced follow up visit to this facility to deliver findings on the above-mentioned allegations of "Resident sustained unexplained injuries while in care and Staff did not seek medical attention for resident in a timely manner". Upon arriving at the facility, LPA met with Assistant Administrator / Joey Perez who assisted with the visit.

LPA Katrdzhyan conducted prior visits to this facility on 11/22/21 and 5/31/23, in reference to the allegations listed above. During the course of the investigation, interviews were conducted of various persons to include the Assistant Administrator, Clients 1 – 3 (C1 - C3), Staff 1 (S1) and Service Coordinator / Michelle Ortega from San Gabriel/Pomona Regional Center (SGPRC). LPA made an attempt to interview Client 4 (C4) but was unsuccessful due to C4 being non-verbal. LPA made multiple attempts to interview Staff 2 (S2) via telephone but was unsuccessful.
(please see LIC 9099C for additional information)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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 4
Control Number 28-AS-20211119074345
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: BRADBOURNE
FACILITY NUMBER: 198603273
VISIT DATE: 06/01/2023
NARRATIVE
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Also, copies of the following documents were obtained and reviewed in reference to C1;

• Client Information Sheet • Admission Agreement • Agreements and Consent for Medical Treatment
• Personal Rights • Individual Program Plan (IPP) • Behavior Consultant Notes • Special Incident Reports
• Hospital/Medical Reports • Facility Client Notes • Body Assessment Sheet • Staff Roster • Client Roster

The investigation revealed the following;

Allegations: Resident sustained unexplained injuries while in care and Staff did not seek medical attention for resident in a timely manner. The details of these allegations state that C1 was placed on a CPI hold which caused injury to C1’s toes (both) and fingernails and staff didn’t seek medical care for C1 until prompted by the family of C1.
Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with these allegations. During the interview of C1, C1 admitted to having ongoing issues with his nails as a result of cutting his nails too short, picking at them and bumping his toes. C1 stated that “maybe the bloody toenails were as a result of staff stepping on my toes during the CPI hold but I’m not sure.” The Administrator and staff also confirmed that C1 had ongoing issues with his nails as a result of cutting his nails too short, picking at them and bumping his toes.
According to the Client Notes documented by staff, on the morning of 11/5/21, the toenails of C1 were observed to be bloody. Later that same afternoon, staff took C1 to the hospital (Emanate Health) for a check-up. According to the hospital report, C1 was diagnosed with Cellulitis of great toe of left foot and Cellulitis of great toe of right foot and recommended to follow up with primary care provider for reassessment. On 11/17/21, C1 had a tele-health visit with his primary care physician (PCP) at ReNovi Medicine. The PCP noted on the report “Cellulitis bilat hallux toes, thinks patient cut nail too short and bumped the toes.” On 11/18/21, C1 saw his PCP (in-person) and the PCP gave a referral for a Podiatrist stating “bilat foot pain and ingrown toenails”. On 12/6/21, C1 was seen by the Podiatrist and diagnosed with “severe ingrown toenail”. On 12/8/21, C1 had a follow up tele-health visit with his PCP at which time the PCP noted “Continue to monitor closely” and recommended for outpatient surgery if no improvement. On 1/21/22, C1 had a follow up visit with the Podiatrist (diagnosed: Rt & Lt hallux cellulitis, recommended surgery). On 1/26/22, C1 had surgery on both toenails (Lt and Rt hallux toenails). The SGPRC conducted an investigation and the following recommendations were made; (please see LIC 9099C for additional information)
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20211119074345
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: BRADBOURNE
FACILITY NUMBER: 198603273
VISIT DATE: 06/01/2023
NARRATIVE
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• Within 30 days, please submit a plan to address how C1 can continue to cut his nails ins a safe manner and prevent further injuries if decided upon and to document the decision in the facility reports and discuss with service coordinator/ID team to confirm if it will be added to IPP report.
• Remind residents to wear shoes, slippers, and or skid resistant socks in the facility. Interviews indicated the C1 was barefoot when he was escorted to his bedroom and explained that C1 kicked and banged his bare feet on the floor during the CPI maneuver.

The recommendations were completed by the facility. This concluded the investigation conducted by SGPRC.
Based on the information gathered during this investigation, there is insufficient evidence to prove the above-mentioned allegations to be true.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of this report was provided to the Assistant Administrator.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4