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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423857
Report Date: 11/29/2021
Date Signed: 11/29/2021 11:42:24 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, 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
11/22/2021 and conducted by Evaluator Shaunte Henry
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211122100210
FACILITY NAME:MCKINLEY CARE HOMEFACILITY NUMBER:
366423857
ADMINISTRATOR:APRILLELYN PANALIGANFACILITY TYPE:
735
ADDRESS:9895 MCKINLEY ST.TELEPHONE:
(909) 910-4633
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:4CENSUS: 4DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:April Panaligan, administrator/caregiverTIME COMPLETED:
11:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Physical abuse
Neglect
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/29/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of investigating the above allegations. LPA met with April Panaligan explained the nature of the visit and was granted entry.

The investigation, which consisted of interviews and file review revealed the following:
Allegations 1: Physical Abuse
During an interview with the administrator, it was reported that Client 1 (C1) sustained falls on 11/8/21, 11/10/21, 11/11/21 and 11/12/21. All 4 staff interviews revealed C1 refuses to use their wheel chair and is combative when staff attempt to assist C1 in ambulating. The LPA observed an incident log that detailed each of the falls. On 11/8/21 C1 fell and hit their head, which caused bruising to the right side of his head.
***Continued on 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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 18-AS-20211122100210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MCKINLEY CARE HOME
FACILITY NUMBER: 366423857
VISIT DATE: 11/29/2021
NARRATIVE
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4
5
6
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8
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10
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12
13
14
15
16
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18
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20
21
22
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32
 ***Continued from 9099***
On 11/10/21 C1's fall resulted in bruising to the left side of his head and the left side of their body. C1 sustained two falls on 11/11/21 which resulted in bruising to right shoulder and the left side of their head. On 11/12/21 C1 fell and hit their head which resulted in a red mark on their left side of their head. C1 was sent to the hospital because they were very agitated and staff did not want C1 to further injure themselves with additional falls.
The LPA interviewed C1, however, when asked about the bruising and the falls, C1 responded that they did not know. A review of C1's Individual Placement Plan (IPP) indicates C1 has no safety awareness and requires supervision at all times to prevent injury/harm. An interview with Client 2 (C2) did not yield any pertinent information due to C2 being non-verbal. The LPA was not able to interview Client 3 (C3) due to being admitted to the hospital or Client 4 (C4) due to them being at their day program. The bruises that C1 had during the LPA's visit on 11/17/21, appeared to be in the end stages of healing to the left and right sides of their head. During today's visit, C1's bruises were no longer visible. The LPA observed a puzzle style floor mat on the floor of C1's bedroom to help mitigate injuries should C1 sustain another fall.
Allegation 2: Neglect
During an interview with C1, C1 stated that they were being properly fed. C1 denied feeling unsafe living in the facility. C1 confirmed that they were happy living in the facility. C1 denied feeling scared of staff. The LPA observed C1 communicating and laughing with staff during the visit. Staff 1 (S1), Staff 2( S2), Staff 3 (S3) and Staff 4 (S4) all denied that C1 is not properly fed. It was reported that C1 has been ill and experienced a decline in their appetite, which may have contributed to their minor weight loss. C1 was admitted to the facility on August 25,2021. On August 26,2021, C1 weighed 145 lbs. On September 27,2021 C1 weighed 151 lbs. On October 25, 2021 C1 weighed 140 lbs. An interview with Client 2 (C2) did not yield any pertinent information due to C2 being non-verbal. The LPA was not able to interview Client 3 (C3) due to being admitted to the hospital or Client 4 (C4) due to them being at their day program. The food menu for November indicates the clients in care are being provided nutritious meals and snacks. The menu also indicates that the menu can be changed based on the clients' choice. C1 raised their shirt and allowed the LPA to see their chest and stomach. C1 is tall and thin, however the LPA determined that C1 did not appear extremely malnourished. 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, therefore the allegations are UNSUBSTANTIATED at this time. An exit interview was conducted where this report, 9099C and LIC 811 were provided to April Panaligan.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2