198601631-10-3-2024-28-AS-RORN-DAAKUT-20241022081313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601631
Report Date: 10/03/2024
Date Signed: 10/03/2024 03:41:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/24/2024 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240924110535

FACILITY NAME:	ST. JUDE'S ELDER CARE III		FACILITY NUMBER:	198601631
ADMINISTRATOR:	JUDY RAGANO		FACILITY TYPE:	740
ADDRESS:	146 SHIRE COURT		TELEPHONE:	(909) 263-3787
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	6	CENSUS: 4	DATE:	10/03/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Judy Ragano, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff handled resident(s) in a rough manner while in care.
Staff spoke inappropriately to resident(s) while in care.
Licensee is retaining resident(s) with a higher level of care need.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an Initial 10-Day complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Administrator, Judy Ragano.

The investigation consisted of: LPA conducted interviews with Administrator, Judy Ragano, Staff #1 (S1) to Staff # 3 (S3), and Former Resident #1 (FR1#) and Resident # 2 (R2) to Resident #4 (R4). Resident #5 (R5) was unable to be interviewed since R5 is in the hospital. LPA requested copies of Staff and Resident Rosters. LPA request FR1 to R5 personnel file documents to be emailed: Identification and Emergency Information, Physician's Report for Residential Care Facilities for the Elderly (RCFE), Preplacement Appraisal Information, Personal Rights, Admission Agreement.

Allegation: Staff handled resident(s) in a rough manner while in care. It is alleged that facility staff handles a resident in a rough and rude manner.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

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 28-AS-20240924110535

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST. JUDE'S ELDER CARE III	FACILITY NUMBER: 198601631
	VISIT DATE: 10/03/2024

NARRATIVE

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Interviews conducted with Admin and three (3) out of three (3) staff revealed that they have not heard or witnessed any staff handled resident in a rough manner. Staff stated that they receive training on Residents Rights on a regular basis and facility has zero tolerance policy on abuse. S1-S2 stated that they never received any report concerning any staff handling residents in a rough manner. S1-S3 denied ever treating any resident aggressively nor handling any resident in a rough manner. FR1 and R2-R4 residents interviewed denied the allegation and indicated that they are satisfied with the services and do not have any concerns. R5 was unable to be interviewed since R5 is currently at the hospital. FR1 and R2-R4 interviewed stated that staff are helpful and assist them whenever they asked. Residents stated that they were never treated aggressively by any staff. Therefore, there was insufficient evidence to corroborate with this allegation.

Allegation: Staff spoke inappropriately to resident(s) while in care. It is alleged that a facility staff speaks inappropriately to and makes rude and inappropriate comments to facility residents.
Interviews conducted with Admin and three (3) out of three (3) staff revealed that the facility staff do not make inappropriate comments to facility residents and do not speak inappropriately to facility residents. Interviews conducted with four (4) out of five (5) residents revealed that the facility have not made rude and inappropriate comments or spoken to them inappropriately. R5 was unable to be interviewed since R5 is currently at the hospital. FR1 and R2-R4 interviewed residents did not have any concerns, stated that they are satisfied with the services they receive at the facility and stated that staff treat them with respect and do not speak and/ or treat them inappropriately. Based on interviews conducted with facility staff, and facility residents, there was not enough supportive evidence to concur with the reported allegation.

Allegation: Licensee is retaining resident(s) with a higher level of care need. It is alleged that the residents here not receiving specialized care in relation to their Dementia / Alzheimer's diagnosis. Interviews conducted with Admin and three (3) out of three (3) staff denied the allegation. Interviews conducted with FR1 and S2-S4 could not corroborate the allegation. Documentation obtained for S1-S2 personnel file staff training annual 8 hour Dementia training date completed 02/10/2024 and S3 annual 8 hours Dementia training date completed 12/21/2024. In addition, all residents interviewed indicated that they feel they receive the required care needed to meet their needs. Per documentation obtained during today's visit, none of the residents are currently diagnosed with Dementia. There is not enough evidence to substantiate.

Based on LPA observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be UNSUBSTANTIATED.

Exit interview was conducted with S1 and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2024

LIC9099 (FAS) - (06/04)

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