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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603306
Report Date: 09/07/2023
Date Signed: 09/07/2023 02:21:50 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-20230829131026
FACILITY NAME:KENDALL GUEST HOME 1FACILITY NUMBER:
198603306
ADMINISTRATOR:GALLEGOS, ANAFACILITY TYPE:
735
ADDRESS:4702 N MAXSON RDTELEPHONE:
(909) 631-8521
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:6CENSUS: 6DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana GallegosTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Resident was not treated with dignity
Facility failed to store and prepare food safely
Facility did not follow plan of operation
Resident did not have control his/her own cash resources.
Staff did not meet resident's needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced 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 conduct a 10 day complaint visit in regards to the above allegations.
At today's visit the following was done:
On 09/06/2023 Resident and Staff Roster submitted.
Interviews were conducted with Administrator, Staff S 1 and Client C 1 from 10:40 PM to 11:50 PM.
The remaining client's were at day Program.
LPA toured facility which included 3 client rooms , dining room, living room and Client rooms 1-3.
In regards to the allegation Resident was not treated with dignity, based on interviews conducted and information gathered Administrator confirmed that staff do take pictures of the client's and then send to her.
Stated that she wants them to look nice and outfits to look good for them.
Staff S 1 also confirmed that staff will take pictures of the client's and send to the Administrator who will offer suggestions.
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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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 6
Control Number 28-AS-20230829131026
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 1
FACILITY NUMBER: 198603306
VISIT DATE: 09/07/2023
NARRATIVE
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Administrator confirmed that the San Gabriel Pomona Regional Center conducted a facility visit and said no more pictures.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
In regards to the allegation Facility failed to store and prepare food safely, based on interviews conducted and information gathered Administrator confirmed that food to be defrosted is left on the counter. Staff S 1 stated that food to be defrosted is left on a table in the backyard or on a counter.
Administrator confirmed San Gabriel Regional Center on past visit observed food defrosted on a counter.
LPA observed canned goods and fruits in a storage shed with no open windows to circulate outside air.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are 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 allegations are 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 allegations are found to be SUBSTANTIATED. Per Title 22, deficiencies are cited.
In regards to the allegation Staff did not meet resident's needs based on interviews conducted and information gathered Administrator confirmed that there are staff who have been here that only have spoken Spanish.
Staff S 1 also stated that staff are mostly Spanish speaking.
Client C 1 stated that it is correct that staff have been only Spanish speaking.
Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are 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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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-20230829131026

FACILITY NAME:KENDALL GUEST HOME 1FACILITY NUMBER:
198603306
ADMINISTRATOR:GALLEGOS, ANAFACILITY TYPE:
735
ADDRESS:4702 N MAXSON RDTELEPHONE:
(909) 631-8521
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:6CENSUS: 6DATE:
09/07/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ana GallegosTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not maintain a comfortable temperature at the facility
INVESTIGATION FINDINGS:
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In regards to the allegation , based on interviews conducted and information gathered Administrator stated that the temperature is comfortable at the facility.
Staff S stated that the temperature is comfortable and C 1 stated the temperature is good at the facility.
LPA toured the following areas and observed the following:
Living Room 75.9 F.
Dining Room 73.7 F.
Room 1 75.5
Room 2 74.7
Room 3 73.7

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.
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: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
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 6
Control Number 28-AS-20230829131026
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 1
FACILITY NUMBER: 198603306
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2023
Section Cited
CCR
80072(a)(1)
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Personal Rights
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.
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Administrator to review 80072 Personal rights and self certify by POC due date that pictures will not be taken of client's by staff and submit documentation confirming English speaking staff at facility.
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This requirement was not met as evidenced by:
Based on interviews conducted Administrator confirmed that staff take pictures of client's and send to her and also staff are Spanish speaking and can't communicate with English speaking client which causes a potential risk to client's in care.
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Type B
09/11/2023
Section Cited
CCR
80076(a)(1)
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Food Services
In facilities providing meals to clients, the following shall apply:

(1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Administrator to submit a plan by POC due date on how staff will handle food preparation.
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This requirement was not met as evidenced by:
Based on interviews and observation Administrator confirmed that food to defrost has been left on the counter and LPa observed fruit and vegetables in storage with no windows which causes 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: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20230829131026
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 1
FACILITY NUMBER: 198603306
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2023
Section Cited
CCR
80022(j)
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Plan of Operation
Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061.
This requirement was not met as evidenced by:
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Administrator removed all cameras .

Deficiency cleared.
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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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Type B
09/11/2023
Section Cited
CCR
80070(a)(b)(14)
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80070.Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. (b) Each record must contain information...:(14)An account of the client's cash resources, personal property, and valuables entrusted...
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Administrator by POC due date will submit a plan to licensing outlining what is to be used for each client's P and I.
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This requirement is not met as evidenced by:
Based on interviews conducted Administrator confirmed that P and I was used for candy bags for each client and not all approved which poses 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: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6