198320129-11-9-2024-11-AS-UCOL-DAYTHR-20241113134511

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320129
Report Date: 09/13/2024
Date Signed: 11/09/2024 10:34:35 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/06/2024 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240906105757

FACILITY NAME:	CASA DE ESTRELLA		FACILITY NUMBER:	198320129
ADMINISTRATOR:	BUSTOS, GLENDA		FACILITY TYPE:	740
ADDRESS:	22313 MADISON STREET		TELEPHONE:	(310) 504-0648
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	6	CENSUS: 6	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Evangeline Agatep, Adminstrator		TIME COMPLETED:	03:11 PM

ALLEGATION(S):

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Staff hit resident.
Staff handled resident in a rough manner.
Staff made inappropriate comment(s) to resident.

INVESTIGATION FINDINGS:

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This is an amendment to deliver an updated number of residents interviewed during the investigation. The census during the time of the department's visit, on 09/13/24, is five (5) residents.
On 09/13/24, The Department of Social Services, Community Care Licensing Division (CCLD) conducted an initial complaint visit at the above-mentioned facility. CCLD staff was met by Evangeline Agatep, Administrator (S3) and the purpose of the visit was explained.
The investigation consisted of the following:
On 09/13/24 CCLD requested facility documents. On 09/13/24, between 10:00AM and 1:45PM interviewed four (4) staff and three (3) out of five (5) residents. One (1) out of five (5) residents was not available for interview and one (1) out of five (5) residents preferred not to be interviewed. LPA conducted a plant inspection, and records were reviewed.

Report continues, see LIC9099C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

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 11-AS-20240906105757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CASA DE ESTRELLA	FACILITY NUMBER: 198320129
	VISIT DATE: 09/13/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation, “Staff hit resident.” It is being alleged that staff are physically abusing residents. Record reviews revealed the following: During the observation of staff records, each staff has completed annual in-service training of 40 hours, directed by Evangeline Agatep, Administrator. Specifically, staff have conducted the "Resident Rights / Reporting Elder & Dependent Adult Abuse" of 3 hours on 02/05/2024 and "Importance & techniques of Personal Care" of 2 hours on 01/22/2024, which verifies that all staff have received trainings on reporting potential elder, and adult, abuse and at how to appropriately assist residents in care. Interviews revealed the following: 4 out of 4 staff and 3 out of 3 residents have disagreed that the allegation has taken place.Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation, “Staff handled resident in a rough manner.” It has been alleged that residents are not being treated with dignity and respect while in care. Record reviews revealed the following: During the observation of staff records, each staff has completed annual in-service training of 40 hours, directed by Evangeline Agatep, Administrator. Specifically, staff have conducted the "Personal assistance and Care including restraints" of 3 hours on 02/19/2024 and "Importance & techniques of Personal Care" on 01/22/2024, which verifies that all staff have received trainings on how to provide personal assistance to residents as they ambulate, the appropriate use of restraints with residents in care and the techniques and importance of staff assisting residents with the residents' personal care. Interviews revealed the following: 4 out of 4 staff and 3 out of 3 residents have disagreed that the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Regarding the allegation, “Staff made inappropriate comment(s) to resident.” It has been alleged that staff are verbally abusing residents in care. Record reviews revealed the following: During the observation of staff records, each staff has completed annual in-service training of 40 hours, directed by Evangeline Agatep, Administrator. Specifically, staff have conducted the "Resident Rights / Reporting Elder & Dependent Adult Abuse" of 3 hours on 02/05/2024 and "Resident Rights" of 2 hours on 01/15/2024, which verifies that all staff have received trainings on the importance of Resident Rights and how and when to report expected abuse(s).

Report continues, see LIC9099-C

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240906105757

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CASA DE ESTRELLA	FACILITY NUMBER: 198320129
	VISIT DATE: 09/13/2024

NARRATIVE

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Interviews revealed the following: 4 out of 4 staff and 3 out of 3 residents have disagreed that the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with Evangeline Agatep (S3), Administrator, and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2024

LIC9099 (FAS) - (06/04)

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