198603560-1-18-2024-28-AS-LHIS-CZXTYF-20240129140838

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603560
Report Date: 01/18/2024
Date Signed: 01/18/2024 03:17:32 PM

Unsubstantiated

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
07/24/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230724154603

FACILITY NAME:	CLIMB SIERRA MADRE RCFE		FACILITY NUMBER:	198603560
ADMINISTRATOR:	VARGAS, HECTOR		FACILITY TYPE:	740
ADDRESS:	161 W. SIERRA MADRE BLVD.		TELEPHONE:	(626) 289-5321
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY:	40	CENSUS: 36	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Hector Vargas a		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff inappropriately touching a resident in care.
Staff not accorded residents dignity in their relationship.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted a subsequent complaint investigation for the allegations listed above. LPA met with Administrator Hector Vargas and dicussed purpose of today's visit.

Initial visit on 7/25/23 consisted of LPA Calderon conducted a health and safety check and obtained a copy of the following for Client #1 (C1) - Client #4(C4): • Client Information/ Face Sheets • Admission Agreements • Agreements and Consent for Medical Treatment • Personal Rights • Individual Program Plan (IPP) • Physician's Reports • Resident Roster and Staff Roster. C1's • Special Incident Reports •Hospital Discharge Report. LPA Calderon alongside with Vargas toured the facility, random rooms, Room # 4,5,10,16 and 20 and common areas included dining room and living room. Medication room was locked. The kitchen was observed and LPA obsevred sufficient perishable and non-perishable food itmes for residents in care. (CONTINUATION 90999-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230724154603

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: CLIMB SIERRA MADRE RCFE	FACILITY NUMBER: 198603560
	VISIT DATE: 01/18/2024

NARRATIVE

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On today's visit 1/18/24, LPA Calderon collected staff training for Catheter Care, Physician Orders for C1 catheter placement and Physician notes regarding C1 receiving incontinent care. LPA interviewed C1-C4 , LPA interviewed Officer Manager and Licensing Vocational Nurse from Adept Home Health Care Services, whom provide services to C1. LPA interviewed Administrator, Staff #1 and Staff #2 (S1 and S2), telephone interview attempts with Staff #3 and Staff # 4. (S3 and S4). LPA interviewed (2) Service Coordinator via telephonically from San Gabriel Pomona Regional Center, whom worked and have worked with C1 and residents at the above facility.

Based on allegation: Staff inappropriately touching a resident in care. Investigation revealed based on interviews with staff, Administrator, S1 and S2 denied the above allegation and stated residents are not touched inappropriately and are not aware of an incident were resident was touched inappropriately. Administrator, S1 and S2 informed LPA residents are treated with respect. S1 and S2 both stated C1 was assisted with activities of daily living (ADL's) and it was reported that C1 was having issues with catheter. S2 informed LPA S1 was not alone during observations when assisting C1 with ADL's, S2 informed LPA they were present with S1 and C1 was not touched inappropriately when caring for ADL's. S1 informed LPA during interview, C1 was not touched inappropriately when assisting C1 with ADL's and informed LPA to have other staff present and staff were ensuring C1 was being observed to provide C1 with appropriate care based on ADL's. LPA interview with C1 revealed C1 answers were inconsistent and interview cannot corroborate with the above allegation. Interviews with clients C2, C3 and C4 informed LPA that they deny the above allegation and staff do not touch them inappropriately or know of any clients whom were touched inappropriately. Interviews reveled that 4 out of 4 clients interviewed had no concerns with staff / S1 coming into their rooms. Interview with Adept Home Health Care Licensing Vocational Nurse whom treats C1 informed LPA not aware of incident were C1 was touched by staff inappropriately. During interviews with C1's former service coordinator and current service coordinator from San Gabriel Pomona Regional Center, both service coordinators informed LPA there has been no concerns regarding C1 and clients at the above facility being touched inappropriately by staff. Based on record review on Catheter Care training, staff are trained on concerns to inform home health nurse and facility administrator regarding catheter clients. Special Incident Report dated 7/24/23 was reported to Licensing and Regional Center regarding C1 received care by licensed professionals due to catheter issues, facility notified home health care and appropriate parties.

(CONTINUATION 9099-C)

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230724154603

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: CLIMB SIERRA MADRE RCFE	FACILITY NUMBER: 198603560
	VISIT DATE: 01/18/2024

NARRATIVE

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Based on allegation: Staff not accorded residents dignity in their relationship. Based on interviews conducted with Administrator, S1 and S2, staff denied the above allegation and informed LPA residents are respected and treated with dignity. Interviews with clients 4 out of 4 clients informed LPA facility staff treat them with dignity. C1-C4 were unaware of any clients whom were not treated according to their dignity. C1 stated S1 treats them with dignity and is nice towards them. Former Service Coordinator and current service coordinator from San Gabriel Pomona Regional Center informed LPA there were no reports regarding residents not being treated with dignity and denied the above allegation, interview with Adept Home Health Care Services informed LPA, C1 has not reported staff not treating resident(s) with dignity.

Based on the LPA's observation, interviews conducted with client and staff and document reviewed, 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 conducted and a copy of this report was provided to Administrator Hector Vargas

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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