336426431-10-30-2023-18-AS-EMAN-CXKVE5-20231114152145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426431
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:27:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2021 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210526094519

FACILITY NAME:	ANGELES HOME CARE		FACILITY NUMBER:	336426431
ADMINISTRATOR:	ANGELES KRAUSE		FACILITY TYPE:	740
ADDRESS:	32650 WESLEY STREET		TELEPHONE:	(951) 226-8259
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	0	CENSUS: 0	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Michelle Matamoros- Administrator		TIME COMPLETED:	01:37 PM

ALLEGATION(S):

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Facility denied access to Ombudsman.
Facility denied Ombudsman access to resident's records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Administrator Michelle Matamoros. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Facility denied access to Ombudsman:

Interviews with staff and residents revealed that the facility does not deny access to Ombudsman representatives. The staff denied not allowing an Ombudsman representatives access into the facility. The residents denied that Ombudsman representatives are not allowed to visit the residents. The staff welcomes the Ombudsman representatives inside the facility and loves the work that they do for the residents. The Ombudsman representatives speak freely to all the residents during visits.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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 18-AS-20210526094519

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGELES HOME CARE	FACILITY NUMBER: 336426431
	VISIT DATE: 10/30/2023

NARRATIVE

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Document review of the facilities visitor log revealed that an Ombudsman representative visited the facility in May of 2021, as well as more recently visited the facility in December of 2022.

For allegation, Facility denied Ombudsman access to resident's records:

Interviews with the staff revealed an Ombudsman representative visited the facility in May of 2021. During this visit, the Ombudsman representative requested to view a residents medical file without stating the reason. The administrator asked the Ombudsman representative to explain the reason they needed to view the resident’s file. The Ombudsman representative denied that they needed a reason to view the resident’s medical file. The administrator informed the Ombudsman representative that they could not access the resident’s medical files. The administrator stated they denied the Ombudsman representative access to the resident's medical files because the Ombudsman representative did not obtain written consent from the resident or the residents legal representative.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Michelle Matamoros, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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