306003751-11-10-2021-28-AS-FFIS-CC82LF-20220304162930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 11/10/2021
Date Signed: 11/10/2021 03:29:42 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
07/31/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200731161045

FACILITY NAME:	CRJ HOME		FACILITY NUMBER:	306003751
ADMINISTRATOR:	CRISTINA SANTOS		FACILITY TYPE:	735
ADDRESS:	15044 BARNWALL STREET		TELEPHONE:	(714) 521-5956
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 4	DATE:	11/10/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Loida Samonte/Facility Manger		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident developed a toe fungus due to neglect while in care.
Staff did not meet resident's grooming needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPA Villalobos was met by staff Arturo Dalguntas. Mr. Dalguntas contacted Loida Samonte/Facility Manger by telephone who joined shortly after. The purpose of the visit was discussed.

Initial visit was conducted telephonically on 8/7/2020. On that visit LPA interviewed Staff #1-#4 (S1-S4) and Client #1-#2 (C1-C2). LPA requested documents from C1's file as well as staff and client rosters.

On todays visit, LPA interviewed Client #3 (C3), reviewed C1's files and delivered findings.

The investigation revealed the following: In regards to allegation, "Resident developed a toe fungus due to neglect while in care." it was alleged that C1 developed a toe nail fungus due to neglect from staff. (4) of (4) denied the allegation. (3) of (3) clients interviewed could not corrborrate the allegation.

Continuned on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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-20200731161045

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: CRJ HOME	FACILITY NUMBER: 306003751
	VISIT DATE: 11/10/2021

NARRATIVE

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Interviews show that C1 developed a toe fungus in February 2020 and that staff were aware. C1 received doctor order for medication that would be applied to the affected area. Review of MARs documentation shows that staff applied the medication daily. C1 stated that staff applied the medication daily as well. The cause of the toe nail fungus is not known. There was not enough supportive evidence to concur with the reported allegation. 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.

In regards to allegation, "Staff did not meet resident's grooming needs." it was alleged that staff failed to meet C1's grooming needs because C1's nails were overgrown. (4) of (4) staff interviewed denied the allegation. (3) of (3) clients interviewed could not corroborate the allegation. Review of C1's file does not state that C1 requires grooming assistance with their toe nails. Review of C1 Individual Program Plan dated 2/3/2020 states that C1 does not receive podiatrist services as C1 prefers to have manicures and pedicures. Interviews show that staff would regularly take C1 and C3 into the community to receive pedicures but due to the Covid-19 pandemic and Safer At Home orders in 2020, C1 was not able to go out into the community to get a pedicure. Documents show that staff scheduled a podiatrist to help with C1's toe nails on 7/29/20. Based on statements and interviews conducted with staff, clients, review of client files and records, there was not enough supportive evidence to concur with the reported allegation. 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.

There are no deficiencies sited at the time of this visit. Exit Interview conducted with staff and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

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