198603638-9-16-2024-28-AS-DSIS-D9EQ5F-20240924115152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603638
Report Date: 09/16/2024
Date Signed: 09/16/2024 12:32:50 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
09/11/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240911162445

FACILITY NAME:	MERCEDES DIAZ HOMES, INC. - JANINE HOME		FACILITY NUMBER:	198603638
ADMINISTRATOR:	HERNANDEZ, ALEJANDRO		FACILITY TYPE:	735
ADDRESS:	14858 JANINE DR		TELEPHONE:	(562) 945-4576
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	4	CENSUS: 4	DATE:	09/16/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Leslie Morales - Direct Support Staff		TIME COMPLETED:	01:14 PM

ALLEGATION(S):

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Staff not transporting resident to scheduled appointments

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted an initial complaint visit to address the allegations listed above. LPA met with Lesly Morales, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Brenda Venegas arrived shortly thereafterwards.

The investigation consisted of the following: During the visit, LPA interviewed Clients #1 - 3 (C1 - C3), Staff members #1 - 4 (S1 - S4), Witness #1 (W1), and also obtained the staff roster, client roster, along with the FACE sheet, the physician's report, Individual Program Plan (IPP), record of medical care, along with record of conversations for C1. LPA attempted to interview Client #4 (C4), however they were currently hospitalized and therefore LPA was not able to interview them.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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-20240911162445

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: MERCEDES DIAZ HOMES, INC. - JANINE HOME	FACILITY NUMBER: 198603638
	VISIT DATE: 09/16/2024

NARRATIVE

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The investigation revealed the following: In regards to the allegation that "Staff did not transport resident to scheduled medical appointments," it is alleged that C1's physician recommended eye surgery in December of 2023, however C1 was not transported to their medical appointments until January of 2024, but by this time it was too late because C1 had lost vision in the eye. During interviews with the clients, zero (0) out of four (4) could not corroborate the allegation that they have not been receiving transportation to their medical appointments. LPA interviewed C1, however LPA was not able to obtain any information related to the allegation. During interviews with the staff, zero (0) out of four (4) interviewed did not corroborate that they did not transport residents to their scheduled medical appointments. During the interview with S1, they explained that the staff were transporting C1 to all of their medical appointments, however there was a delay in C1 obtaining the eye surgery because C1 required a prior authorization through their medical insurance to stay in a Skilled Nursing Facility (SNF) for after care. S1 explained that the prior authorization was required because the facility was not equipped to handle the after care for C1. S1 also explained that there was delay on C1 obtaining the authorization because there was some miscommmunication between the East Los Angeles Regional Center (ELARC) service coordinator of C1 and C1's conservator regarding who was responsible for initiating the authorization. On 3/15/2024 C1 along with their conservator had a follow up appointment with C1's ophthalmologist, and during this appointment the physician recommended that C1 should not have the eye surgery due to the possibility of getting an infection due to their behaviors. During review of the record of medical conversations with C1's ophthalmologist, it is documented that C1's conservator agreed during the appointment on 3/15/2024 that C1 should not have their eye surgery due to the risks involved.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, 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, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC9099 (FAS) - (06/04)

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