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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603442
Report Date: 02/02/2023
Date Signed: 02/02/2023 04:50:29 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
01/24/2023 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230124134141
FACILITY NAME:MAGNOLIA HOME CAREFACILITY NUMBER:
198603442
ADMINISTRATOR:BAYNOSA, STEPHANIEFACILITY TYPE:
735
ADDRESS:291 MACALESTER DRIVETELEPHONE:
(951) 231-8248
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY:4CENSUS: 3DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Kristine Jimenez and Stephanie Baynosa, AdministratorTIME COMPLETED:
04:59 PM
ALLEGATION(S):
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Staff did not treat the clients fairly during an event
Staff mishandled a client's personal funds while in care
Facility has insufficient staffing for the clients
Client was not afforded privacy while in care
Staff do not have planned activities for the clients
Staff behavior posed as a risk to a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced initial complaint visit. On today's visit LPA was greeted by DSP Kristine Jimenez and later met with Administrator, Stephanie Baynosa and explained the reason for the visit.
The investigation consisted of interviews with 4 Clients (C1 – C4), 5 staff S1 – S5) and 1 witness (W1). LPA also reviewed and obtained copies of P & I logs for March and April 2022, staff and resident rosters, activity log for C4, IPP, Quarterly progress report for C4 and San Gabriel Regional Center investigation findings.

Regarding Allegation: Staff did not treat the clients fairly during an event. It is alleged that staff have celebrations and food on occasion and do not included or share with clients. 5 of 5 staff denied the allegations. 2 of 4 clients could not collaborate the allegations. W1 did not collaborate the allegations.

(CONTINUE ON 809C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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 2
Control Number 28-AS-20230124134141
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: MAGNOLIA HOME CARE
FACILITY NUMBER: 198603442
VISIT DATE: 02/02/2023
NARRATIVE
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Regarding Allegation: Staff mishandled a client's personal funds while in care. It is alleged that facility mishandled P & I monies from C4. W1 is payee of C4 and handles C4 P & I. There is no evidence that facility ever handled any P & I money for C4.

Regarding Allegation: Facility has insufficient staffing for the clients. It is alleged that there is not enough staff on duty to assist clients with their needs. 5 of 5 staff denied that allegations. 3 of 4 clients could not collaborate the allegations. There are 12 total staff and there are 2 during the day and 1 overnight on rotating schedule. W1 could not collaborate the allegations. LPA reviewed schedule and it show there to be coverage 24 hours a day.

Regarding Allegation: Client was not afforded privacy while in care. It is alleged that staff do not provide privacy to client when showering. 5 of 5 staff denied the allegations. Staff stated that they will assist the clients for their own safety but if clients can take care of their own personal care, they are afforded privacy. 2 of 4 clients could not collaborate the allegation. W1 did could not collaborate the allegation.

Regarding Allegation: Staff do not have planned activities for the clients. It is alleged that staff do not have activities for clients. 5 of 5 staff denied the allegations. 2 of 4 clients denied the allegations. W1 stated that they don’t have activities that C4 enjoys and can participate. LPA observed a weekly activity schedule on the wall by the front door and reviewed pictures of clients and staff participating in activities.

Regarding Allegation: Staff behavior posed as a risk to a client while in care. There were not any details regarding this allegation and 5 of 5 staff denied that their behaviors or those of other staff pose a risk to clients. 3 of 4 clients denied the allegations and W1 stated W1 didn’t know what this allegation may be about but one time a trip was made to a casino that included 2 staff and C1 and C4. S1 stated that on that occurrence, 2 staff and 3 clients made the trip to the casino and included a stop at the mall with consent from all 3 (C1-C3). C1 collaborated this when asked if it was his decision. C4 also mentioned that he participated on this excursion. C3 did not go because C3 was working.

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 allegations are UNSUBSTANTIATED.



Exit interview held. A copy of the report was provided to Facility Staff Kristine Jimenez.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2