198603425-11-21-2023-28-AS-RORN-CY32ED-20231129161947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603425
Report Date: 11/21/2023
Date Signed: 11/21/2023 02:25:07 PM

Unsubstantiated

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
09/09/2022 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220909140233

FACILITY NAME:	CLAREMONT HACIENDA, THE		FACILITY NUMBER:	198603425
ADMINISTRATOR:	PAOLI, FREDERICK		FACILITY TYPE:	740
ADDRESS:	501 SOUTH COLLEGE AVENUE		TELEPHONE:	(909) 626-0117
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	0	CENSUS: 0	DATE:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Donell Clark - Executive Director		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff yelled at resident.
Staff are not following masking requirements to prevent the spread of COVID.
Staff do not properly dispose of waste.
Facility air condition is in disrepair.
Staff did not maintain a comfortable temperature in the facility.
Staff did not respond to resident's call for assistance in a timely manner.
Staff are storing items which could pose a risk to residents in an accessible bedroom.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above-mentioned allegations. LPA met with Executive Director Donell Clark and explained the reason for the visit.

The investigation consisted of the following:
LPA Glen Truman conducted the initial 10 day visit on 9/16/2022, LPA collected copies of Staff and Resident Rosters, Interviewed 3 staff, and toured the facility. Due to insufficient information available at the time, further investigation was needed.
LPA Tena Herrera conducted a subsequent visit on 11/21/2023, LPA collected copies of Staff and Resident Rosters, Interviewed 6 Staff and 5 Residents. This facility had a recent change of ownership in December 2022 (new facility # 198603567). LPA is investigating complaint under closed facility number. Staff and Residents interviewed during visit were all present prior to change of ownership.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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-20220909140233

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: CLAREMONT HACIENDA, THE	FACILITY NUMBER: 198603425
	VISIT DATE: 11/21/2023

NARRATIVE

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The investigation revealed the following:

Allegation: Staff yelled at resident.

It is alleged that a staff member was speaking aggressively and loudly to a resident during feeding. LPA interviewed 6 Staff and 5 out of 6 staff stated they have never, nor have they ever witnessed another staff member yell or raise their voice at a resident in an aggressive manner. 5 out of 6 staff either do not remember the staff that allegedly yelled at resident or have not witnessed such staff yell/raise voice at residents (accused staff no longer works at facility and was not on the facility staff roster). LPA interviewed 5 residents and 5 out of 5 residents denied the above allegation and stated they have never been yelled at by a staff member and feel that staff treat them with respect.

Allegation: Staff are not following masking requirements to prevent the spread of COVID.

It is alleged that Staff were either wearing masks inappropriately (pulled down to chin) or not at all and not following the COVID masking mandates. 6 out of 6 Staff interviewed denied the above allegation and stated that when there were mask mandates in order the facility followed the most up to date regulations. 5 out of 5 residents interviewed denied the above allegation and stated that when masking was in order they always saw staff wearing masks.

Allegation: Staff do not properly dispose of waste.

It is alleged that staff were not proper disposing of diapers/changing pads and possibly biohazard waste. 6 out of 6 staff denied the above allegation and stated that the facility has had a procedure in place to properly dispose of both biohazard and incontinence waste and continue to follow such procedure to this date. Procedure for waste includes of disposing incontinence waste immediately after changing a resident, prior to assisting another room bags used for waste is taken to dumpster and separate bag used for soiled linens to laundry. Staff stated the facility med-cart is and has been equipped with a biohazard locked waste tin and is disposed of properly and separate from all other waste when needed. Interviews with Residents, 5 out of 5 residents all confirmed that staff throw away incontinence waste immediately after changing residents and have not seen any waste being disposed of inappropriately.

(Continued on LIC9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220909140233

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: CLAREMONT HACIENDA, THE	FACILITY NUMBER: 198603425
	VISIT DATE: 11/21/2023

NARRATIVE

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Allegations: Facility air condition is in disrepair & Staff did not maintain a comfortable temperature in the facility.
It is alleged that the temperature was very high in the facility and facility failed to take appropriate measures to accommodate the residents. LPA interviewed 6 staff and 6 out of 6 staff stated that the air conditioner being down may or may not have happened (they are unsure of the time when the air conditioner was down), however, when the air conditioner is down in one unit (there are a total of 5) residents are relocated to another unit or the facility will utilize portable air conditioners to accommodate the residents and ensure the facility is maintained at a proper temperature. Interviews with residents 5 out of 5 residents did not recall the air conditioner ever being out of order and have not experienced the facility to be uncomfortably warm/cold at any time.

Allegation: Staff did not respond to resident's call for assistance in a timely manner.
It is alleged that residents were calling for help and staff were to busy on a different side of the building to answer to the calls for help. Interviews with staff 6 out of 6 staff denied the above allegation and stated that when residents call for help they try their best efforts to respond quickly, only exception is if staff is busy assisting another resident with bathing, changing or one who is a fall risk. Staff stated there is appropriate coverage to assist residents in the case that one staff isn’t available, and staff utilize walkie talkies to communicate when help is needed. Interviews with residents 5 out of 5 residents denied the above allegation and stated that any time they needed help, staff arrived in a quick matter of time. One resident stated that although sometimes it can take staff a little longer to assist, it does pertain to what the emergency is and if staff are assisting a client with a more urgent matter.

Allegation: Staff are storing items which could pose a risk to residents in an accessible bedroom.
It is alleged that a client bedroom was being used for storage and such room was marked as a resident’s room. Interviews with staff 6 out of 6 staff denied the above allegation and stated that resident bedrooms have never been used as a means of storage, facility has 2 storage rooms where they store any extra items, cleaning supplies or hazardous items, and both storage rooms are kept locked at all times. Interviews with residents 4 out of 5 residents denied the above allegation and stated they have never seen a resident room be used as storage, although a room has been observed with an extra bed at one point, such room was a vacant room and was kept locked.
(Continued on LIC9099-C)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20220909140233

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: CLAREMONT HACIENDA, THE	FACILITY NUMBER: 198603425
	VISIT DATE: 11/21/2023

NARRATIVE

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Based on statements and interviews conducted with staff and residents, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview held with Executive Director Donell Clark. Facility with complaint has been closed as of 12/29/22, due to change of ownership. LPA will be mailing copy of report to Licensee’s last known mailing address.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Tena Herrera	TELEPHONE: 323-980-4633
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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