306006175-9-13-2024-22-AS-AORZ-D99VZ3-20240919165205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006175
Report Date: 09/13/2024
Date Signed: 09/13/2024 11:07:59 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/31/2024 and conducted by Evaluator Kimberly Lyman

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240131151142

FACILITY NAME:	HOLY FAMILY GUEST HOME		FACILITY NUMBER:	306006175
ADMINISTRATOR:	DAMICOG, TERESITA		FACILITY TYPE:	740
ADDRESS:	13372 GARDEN GROVE BLVD		TELEPHONE:	(714) 643-0661
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92843
CAPACITY:	6	CENSUS: 4	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Mylene Baldazo		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Resident was sexually abused while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, the department interviewed staff, residents and witnesses as well as reviewed and obtained pertinent documentation such as Garden Grove Hospital medical records dated 01/28/2024. Regarding the allegation that resident was sexually abused while in care, the investigation revealed the following: Resident 1 (R1) was admitted to Garden Grove Hospital on 01/28/2024 for respiratory distress, hypotensive, acute renal failure and significant lactic acidosis. While in the process of inserting a foley catheter, the nurse observed swelling and a scratch in the resident’s vaginal area. The resident is deaf/ mute and does not use sign language. The charge nurse was summoned to assess and attempted to communicate with the resident through gestures. Through gestures made by the resident, the nurse determined that the resident had been sexually abused during care. Garden Grove Police Department was notified, and the responding officer was unable to ascertain if CONT ON LIC 9099C DATED 09/13/2024

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

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 22-AS-20240131151142

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: HOLY FAMILY GUEST HOME	FACILITY NUMBER: 306006175
	VISIT DATE: 09/13/2024

NARRATIVE

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the resident had been sexually abused due to lack of information as well as a lack of examination for sexual abuse. Report narrative from the officer indicates the officer did not think the resident was a victim of sexual assault but could not rule out the possibility due to lack of testing. Resident was hospitalized with a urinary tract infection as well as sepsis rendering the resident unable to submit for a sexual abuse examination. Per police report, Garden Grove Hospital Nurse Practitioner indicated that sepsis could be a possible reason for the bleeding and swelling in the vaginal area. After hospitalization, the resident transferred to Garden Grove Care Center. Interview with Director of Nursing at Garden Grove Care Center indicated no concerns or signs of abuse on resident and added that the resident had an acute urinary tract infection along with sepsis and it is not uncommon for patients to develop moisture related skin damage while wearing briefs. During the investigation, the department interviewed facility staff. The staff indicated only female staff provide showering and incontinence care to female residents. Four out of four staff interviewed denied any abuse occurring and state the resident has a habit of scratching. Garden Grove Hospital staff indicating observing the resident scratching everywhere including the vaginal area. The department attempted to interview three residents at the facility. Only one resident was able to respond to questioning and that resident denied any abuse occurring at the facility.
Per Physician Report dated 11/29/2024, R1 is diagnosed with Moderate Intellectual Disability. Report from Behavioral Services dated 12/01/2023 indicates the resident participates in self injurious behaviors such as scratching and has monthly goals to reduce the amount of scratching.
Based on interviews conducted and record review, the department is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

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