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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603297
Report Date: 06/11/2024
Date Signed: 06/11/2024 03:16:19 PM

Substantiated


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
08/29/2023 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230829130550
FACILITY NAME:KENDALL GUEST HOME 2FACILITY NUMBER:
198603297
ADMINISTRATOR:GALLEGOS, ANAFACILITY TYPE:
740
ADDRESS:4700 N MAXSON RDTELEPHONE:
(909) 631-8521
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:9CENSUS: 6DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana GallegosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident was not treated with dignity
Resident was not provided privacy
Facility did not follow plan of operation
Resident did not have control his/her own cash resources
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced subsequent visit to the facility and was greeted by Administrator Ana Gallegos and explained the reason for the visit.
The purpose of the visit is to deliver findings in regards to the above allegations.
At today's visit the following was done:
On 06/11/2024 Resident and Staff Roster submitted.
Interviews were conducted with Administrator, Staff S 1 and Residents R1 and R2 from 09:30 AM to 11:50 AM.
The remaining residents were at Day Program.
In regards to the allegation Resident was not treated with dignity, based on interviews conducted and information gathered Administrator confirmed that staff had taken pictures of the client's and then sent to her. Stated that she wants them to look nice and outfits to look good for them.
Administrator confirmed that the San Gabriel Pomona Regional Center conducted a facility visit and said no more pictures.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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 5
Control Number 28-AS-20230829130550
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: KENDALL GUEST HOME 2
FACILITY NUMBER: 198603297
VISIT DATE: 06/11/2024
NARRATIVE
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Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
In regards to the allegation Resident was not provided privacy, based on interviews conducted and information gathered Administrator confirmed that the Regional Center Representative did observe a resident in the bathroom with the door open.
Stated she was aware of it and would ensure privacy for all residents.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
In regards to the allegation Facility did not follow plan of operation, based on interviews conducted and information gathered Administrator stated that there were cameras in common areas and she did not notify San Gabriel Pomona Regional Center or Licensing.
Staff S1 stated that there have been cameras in facility to ensure client safety.
Administrator confirmed that San Gabriel Pomona Regional Center on a past visit observed the cameras.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
In regards to the allegation Resident did not have control his/her own cash resources., based on interviews conducted and information gathered Administrator stated that on birthday celebrations each client would get a candy bag and $5 would be taken from P and I without all client's approval. Said on occasions client might want a certain food for their celebration and all client's P and I will be used without their approval.
Administrator confirmed that San Gabriel Pomona Regional Center on a past visit spoke about not using client's P and I without their input.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/29/2023 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230829130550

FACILITY NAME:KENDALL GUEST HOME 2FACILITY NUMBER:
198603297
ADMINISTRATOR:GALLEGOS, ANAFACILITY TYPE:
740
ADDRESS:4700 N MAXSON RDTELEPHONE:
(909) 631-8521
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:9CENSUS: 6DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ana GallegosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility failed to store and prepare food safely
Resident's bedroom door was used as a facility entrance
Staff did not maintain a comfortable temperature at the facility
Staff did not meet resident's needs
INVESTIGATION FINDINGS:
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In regards to the allegation Facility failed to store and prepare food safely, based on interviews conducted and tour of the kitchen and food supply LPA observed a 2 day supply of perishables and 7 day supply non-perishables. Inside food storage room was a device that when switched on would provide fresh air inside for fruits and vegetables.
LPA did not observe any perishables on the counter.
Interviews with Administrator and staff revealed that the facility is practicing safe food practices and not leaving food on the counters.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
In regards to the allegation Resident's bedroom door was used as a facility entrance, based on interviews conducted and information gathered Resident R1 and R2 stated that residents room is not used to walk into the facility.
Interview with staff who stated that residents rooms are not used as an entrance to the facility.
LPA on initial visit on 09/07/2023 and today 06/11/2024 did not observe anyone walk into residents room
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20230829130550
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: KENDALL GUEST HOME 2
FACILITY NUMBER: 198603297
VISIT DATE: 06/11/2024
NARRATIVE
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as a facility entrance.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
In regards to the allegation Staff did not maintain a comfortable temperature at the facility, based on interviews conducted and information gathered Administrator stated that the temperature is comfortable at the facility.
Staff S1 stated that the temperature is comfortable and they try to keep it average for everyone because some get cold and some get hot. R1 and R2 stated the temperature is good at the facility and if hot they put on the air conditioner and if cold they will put on the heater.
LPA measured temperature in the common area at 72.3F meeting Title 22 Regulations.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
In regards to the allegation Staff did not meet resident's needs, based on interviews conducted and information gathered R1 and R2 stated that there is 1 English speaking staff and 1 Spanish speaking staff.
Administrator stated that there has been a staff speaking English at this facility.
Interview with Staff 1 who spoke English and Spanish and stated he communicates in both languages whenever needed to be able to meet all residents needs.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20230829130550
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: KENDALL GUEST HOME 2
FACILITY NUMBER: 198603297
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2024
Section Cited
CCR
87468.1(a)
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Personal Rights of Residents in All Facilities
Residents in all residential care facilities for the elderly shall have all of the following personal rights:

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
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Administrator to review 87468.1 Personal rights and self certify by POC due date that pictures will not be taken of client's by staff, residents will have privacy, and resident monies will not be used without their consent.
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Based on interviews conducted Administrator confirmed that staff take pictures of client's and send to her, also resident did not have privacy with the door open when using the restroom and Residents’ monies are being used to purchase clothing and birthday decorations, without resident input. which causes a potential risk to residents in care.
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Deficiencies cleared on 09/11/2023 with the same allegations for Kendall 1.
Type B
06/13/2024
Section Cited
CCR
87208(a)
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Plan of Operation
Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval.
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Administrator had removed all cameras before initial visit conducted on 09/11/2023.

Deficiency cleared.
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This requirement was not met as evidenced by:
Based on interviews conducted Administrator stated that cameras were in common areas and was not approved by licensing which posed a potential risk to client's in care.
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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: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5