415601129-11-21-2023-14-AS-KHOS-D2DM8B-20240212082248

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601129
Report Date: 11/21/2023
Date Signed: 11/21/2023 04:21:41 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/20/2023 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20231120125621

FACILITY NAME:	JLA HEALTHCARE SERVICES LLC		FACILITY NUMBER:	415601129
ADMINISTRATOR:	LEONARD, JEROME		FACILITY TYPE:	740
ADDRESS:	1185 ACACIA STREET		TELEPHONE:	(650) 477-2857
CITY:	MONTARA	STATE: CA	ZIP CODE:	94037
CAPACITY:	24	CENSUS: 18	DATE:	11/21/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Eloisa Bustamante		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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- Staff recorded or live broadcased residents onto a public social media platform

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Jaime Vado and John Calandra conducted an unannounced complaint investigation visit to open the investigation into the allegations received. During today's visit LPAs met with administrator Eloisa Bustamante and explained the purpose of today's visit.

During today's visit LPAs made facility observations. LPAs were able to determine which room of the facility the video recording took place based on the surroundings observed in the video. The video did show resident faces as well which is a violation of resident personal rights. LPAs also interviewed the staff person (S1) who broadcasted the video and S1 did confirm that S1 posted the video to their personal social media account. According to S1 they only posted it with good intiontions and that they did not know they were not allowed to post such without consent. This allegation is substantiated.

Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D. Report is reviewed with Eloisa.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

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 14-AS-20231120125621

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: JLA HEALTHCARE SERVICES LLC	FACILITY NUMBER: 415601129
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/22/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.	1 2 3 4 5 6 7	Licensee shall ensure that a violation of this regualtion shall not occur in the future. According to the administrator today, she will conduct training and inform staff that it is not allowed and will go over scenarios about what is a personal rights violation as well as sign off acknowledging the understaning of person rights.
	8 9 10 11 12 13 14	This regulation was not met as evidenced by: Per video evidence received it was observed that residents were being recorded/broadcasted and posted onto a public social media platform without consent. S1 was interviewed and S1 confirmed posting the video to S1's social media account. S1 did not observe residents’ personal rights and accorded their dignity as staff videotaped residents and posted the video in Facebook/social media	8 9 10 11 12 13 14	POC to be received by due date stated 11/22/2023.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: April Cowan	TELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2023

LIC9099 (FAS) - (06/04)

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