198603749-8-4-2026-28-AS-FFIS-DWPUMW-20260806154300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603749
Report Date: 05/21/2026
Date Signed: 08/04/2026 11:22:39 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/15/2026 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260515084922

FACILITY NAME:	ST MATTHEW'S HOME FOR THE ELDERLY III		FACILITY NUMBER:	198603749
ADMINISTRATOR:	BOISTON, BARBARA		FACILITY TYPE:	740
ADDRESS:	1654 E RUDDOCK ST.		TELEPHONE:	(626) 253-5806
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	6	CENSUS:	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	10:51 AM
MET WITH:	Administrator, Barbara Boiston		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident sustained bruises due to neglect or physical abuse

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA ) Vaid conducted an unannounced visit for the above-mentioned complaint, met with Administrator Barbara Boiston and explained the reason for the visit. LPA Vaid and Administrator toured the facility and did not observe any health and safety concerns.

LPA Vaid requested and reviewed the following document: Resident 1 (R1) face sheet/ID, physicians report, medications list. Staff and resident rosters. Home Health agency contacts information.

Regarding the allegation: Resident sustained bruises due to neglect or physical abuse. It is alleged that a resident sustained bruising to their body due to neglect or physical abuse by the facility staff. Three of three staff interviewed deny this allegation, staff stated they are proactive with the residents in their care and tend to their needs and services daily. Staff stated some residents have unsteady gaits and often bump into furniture and sustained bruising on their person.
CONTINUED ON 9099C...............

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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-20260515084922

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST MATTHEW'S HOME FOR THE ELDERLY III	FACILITY NUMBER: 198603749
	VISIT DATE: 05/21/2026

NARRATIVE

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Staff stated reporting to physicians and family of the incidents of sever dizziness and muscle cramps causing residents to involuntarily cause injury to themselves. Staff stated they escort each resident to the family /activity areas in the morning and assist residents with using their walker or providing walking assistance when needed. Five of six residents could not corroborate with this, residents stated they are unaware of this happening. One of six residents stated they are not being abused by the staff and that the resident is experiencing weakness using the walker and transferring from bed to wheelchair, the resident stated feeling too weak to walk unassisted and has experience bruising due to fragility of the skin. Medical records show that R1 is prescribed medications that make R1 dizzy and experience muscle fatigue. Majority of the medications R1 are prescribed are known to cause dizziness, muscle cramping, and light-headedness causing R1 to injure themselves. Review of R1’s physician report dated 03/06/2026 has history of skin breakdown, and pressure induced deep tissue damage causing bruising to the resident. Primary physicians are aware of residents’ physical condition and residents’ susceptible to weakness and dizziness caused by the interactions of the prescribed medications that has led to a resident striking a surface and bruising their body. R1 does not receive home health, R1’s family has stopped using home health agency as of 04/09/2026.

Based on records review and interviews conducted, 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 allegation is unsubstantiated.

Exit interview was held and copy of this report was provided to the Administrator, Barbara Bioston.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

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