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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004662
Report Date: 11/17/2023
Date Signed: 11/17/2023 03:47:00 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/20/2020 and conducted by Evaluator Jenifer Tirre
COMPLAINT CONTROL NUMBER: 22-AS-20201020143427
FACILITY NAME:CATHERINE'S RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004662
ADMINISTRATOR:MICHAEL SAN DIEGOFACILITY TYPE:
735
ADDRESS:700 WEST AVENUETELEPHONE:
(714) 879-5139
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:6CENSUS: 6DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
03:19 PM
MET WITH:Caregiver Sylvia BarlahanTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Client left on toilet for hours each day since March 2020
Staff not sufficient to meet clients needs
Licensee uses another client to assist with moving client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre made a unannounced visit and met with Caregiver Sylvia Barlahan to discuss the finding for the above allegations. The investigation consisted of interviews with staff, clients and Regional Center Staff. The investigation also consisted of reviewed documentation such as Regional Center of Orange County Individual Program Plan, Physician’s Report, and Facility In Service Trainings. The Investigation revealed the following:

On 6/16/2020 the department received allegations that facility had Client left on toilet for hours each day since March 2020, Staff not sufficient to meet client’s needs, and Licensee uses other client to assist with moving client. Per Interviews conducted with staff three of three staff interviewed confirmed that Client 1 has a slow range of motion due to their medical condition. Staff confirm that Client 1 requires assistance for ADL’s such as showering, toileting, steering of wheelchair, transporting from bed to wheelchair, transporting from wheelchair to shower chair, and transporting on and off toilet. Interviews revealed that Client 1 is able to communicate need in using the restroom. Staff Interviews confirm that Client 1 is transported to the toilet by
CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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 22-AS-20201020143427
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CATHERINE'S RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004662
VISIT DATE: 11/17/2023
NARRATIVE
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staff. Staff confirm that Client 1 has difficulty moving and can take a while going to the restroom. Interviews with staff and Client 1 confirms that Client 1 has been left sitting on the toilet anywhere between 15 to 30 minutes depending on Client movement. Interviews confirm staff are nearby for client. Client confirms that they communicate with staff when they are finished using the toilet. Interview with Regional Center staff confirms that they have observed staff constantly checking in on clients during restroom breaks and confirms that clients notify staff when they are finished and or need assistance cleaning themselves. Regional Center interview confirms that they have not encountered any issues regarding toileting with Client 1.

Clients Individual Program Plan (IPP) dated 2/16/2023 and Physician’s Report dated 5/21/23 both confirm Client is Non-Ambulatory and primary diagnosis is Cerebral Palsy. IPP confirms that Client 1 requires special equipment such as a manual wheelchair and walker due to Client’s limited range of motion. Client’s IPP mentions Client can not be left alone in bathroom, requires staff to be nearby and confirms that restroom support is offered every 2 hours for Clients. Clients IPP also confirms that client 1 is able to inform staff of toileting needs as well as allowing physical support with transferring on and off toilet.

First quarter progress report from Regional Center of Orange County dated 5/21/23 confirms that client is receiving program support so that client can have 1:1 staffing support. This support has been put into place addressing clients needs for increased staff assistance due to clients decline in mobility. Facility interviews and LPA observations confirm Client 1 has a caregiver providing 1:1 care.

Facility Personnel report and interviews confirm at initial date of received complaint, facility had 5 to 9 staff either living in facility or on call during the start of Covid pandemic in 2020. Interviews confirm that the facility has at least 2 caregivers for AM and PM shifts.

Interviews with staff and Client 1 confirm that to their knowledge clients have not assisted moving other clients. Facility documents confirm staff have had in service training on proper way of transferring residents, Body mechanics, lifting techniques and Client Personal Rights.

Based off interviews, documents and observations, the allegations, Client left on toilet for hours each day since March 2020, Staff not sufficient to meet clients needs, and Licensee uses another client to assist with moving client are deemed UNSUBSTANTIATED. Although the allegations may have happened or is valid there is no preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted with Caregiver and a copy of report was provided to facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
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