198603306-11-4-2023-28-AS-RORN-CXMM9V-20231116082522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603306
Report Date: 11/04/2023
Date Signed: 11/04/2023 02:38:37 PM

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
08/29/2023 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230829131026

FACILITY NAME:	KENDALL GUEST HOME 1		FACILITY NUMBER:	198603306
ADMINISTRATOR:	GALLEGOS, ANA		FACILITY TYPE:	735
ADDRESS:	4702 N MAXSON RD		TELEPHONE:	(909) 631-8521
CITY:	EL MONTE	STATE: CA	ZIP CODE:	91732
CAPACITY:	6	CENSUS: 6	DATE:	11/04/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Yolanda Valdez-Caregiver		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

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:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Ramirez conducted subsequent complaint visit on 11/04/23 to issue the correct citation for the allegation: Resident did not have control his/her own cash resources. The findings remains the same, however, the citation issued on 9/7/23 will be changed from 80070(a)(b)(14) to 85072(b)(7).

The investigation consisted of the following: On 9/7/23 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.

See 9099-C for continuation.

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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-20230829131026

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: KENDALL GUEST HOME 1	FACILITY NUMBER: 198603306
	VISIT DATE: 11/04/2023

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

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.

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.

See 9099-C for continuation.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: KENDALL GUEST HOME 1	FACILITY NUMBER: 198603306
	VISIT DATE: 11/04/2023

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

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.

Exit interview conducted and a copy of this report, 9099-D and appeals rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
GREATER LA AC/SC, 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: 11/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/11/2023 Section Cited CCR 85072(b)(7)	1 2 3 4 5 6 7	85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights. (7) To possess and control his/her own cash resources. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator by POC due date will submit a plan to licensing outlining what is to be used for each client's P and I.
	8 9 10 11 12 13 14	Residents’ monies are being used to purchase clothing and birthday decorations, without resident input.	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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4