197607612-6-22-2023-28-AS-TVAO-CU3P88-20230725110504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607612
Report Date: 06/22/2023
Date Signed: 06/22/2023 03:02:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230620171952

FACILITY NAME:	MONACO CREST GUEST HOME		FACILITY NUMBER:	197607612
ADMINISTRATOR:	CARINA DEMMAN		FACILITY TYPE:	740
ADDRESS:	15225 METROPOL DRIVE		TELEPHONE:	(562) 693-9470
CITY:	HACIENDA HEIGHTS	STATE: CA	ZIP CODE:	91745
CAPACITY:	6	CENSUS: 6	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Wenceslao "Ben" Paule/S-1		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Personal Rights: Resident sustained bruising caused by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the complaint visit to investigate the above allegation. LPA met with Wenceslao "Ben" Paule/S-1 and explained the purpose of today's visit. Carina Demman (Administrator) arrived at this facility at approximately 10:10 A.M..

During today's visit, LPA conducted a tour of this facility. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA obtained Staff and Resident rosters. LPA reviewed files for Resident #1 (R-1) through Resident #6 (R-6) and obtained relevant information. LPA also reviewed files for Staff #1 (S-1) and Staff #2 (S-2) and obtained relevant information. LPA interviewed R-1 and R-4. LPA was unable to interview R-2, R-5 and R-6 as they were asleep. R-3 is currently hospitalized. LPA interviewed R-3's family members via telephone. Per R-3's family members, R-3 difficult to understand when interviewed. LPA interviewed S-1 through S-3.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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 28-AS-20230620171952

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: MONACO CREST GUEST HOME	FACILITY NUMBER: 197607612
	VISIT DATE: 06/22/2023

NARRATIVE

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Allegation: Personal Rights: Resident sustained bruising caused by staff. Staff interviews revealed that staff do not hit and/or cause residents to sustain bruises. Per Staff interviews, staff have not observed anyone hitting and/or causing residents to sustain bruises. Per Staff interviews, staff have not received any complaints/concerns in regards to this matter. Staff interviews revealed they are trained in Mandated Reporting and Resident Rights. Per staff interviews, R-3 has a tendency of falling (due to R-3 wanting to complete tasks on R-3's own) and that lately, R-3 has been compressing R-3's face onto R-3's bed rail which may have led to R-3's bruise on face and not staff hitting R-3. Per R-3's family member interviews, they do not have any concerns in regards to this matter and indicated that R-3 attempts to do things on R-3's own which has led to R-3 falling. Interviewed Residents indicated they are happy with the services provided by staff from this home and do not have any concerns. Per Resident interviews, staff do not hit residents. Interviews and reviewed documentation do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Carina Demman (Administrator). Note: LPA was experiencing technical difficulties during this visit.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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