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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601631
Report Date: 10/25/2025
Date Signed: 10/25/2025 11:11:40 AM

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
03/28/2025 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250328145917
FACILITY NAME:ST. JUDE'S ELDER CARE IIIFACILITY NUMBER:
198601631
ADMINISTRATOR:JUDY RAGANOFACILITY TYPE:
740
ADDRESS:146 SHIRE COURTTELEPHONE:
(909) 263-3787
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY:6CENSUS: 6DATE:
10/25/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Josie Alberto - CaregiverTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Resident sustained a pressure injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegation. LPA met with Josie Alberto Caregiver and explained the reason for the visit.

The investigation consisted of the following: On 4/1/25 LPA Flores conducted an initial investigation visit and collected pertaining documents. On 4/23/25 LPA Flores requested resident #1(R1) medical records. On 5/13/25 LPA Flores received documents from Home Health agency. On 6/9/25 LPA Flores received hospital medical records. On 7/29/25 LPA Flores requested a clinical consult to the department’s clinical consult program. On 10/25/25 LPA Flores conducted a subsequent complaint visit and delivered findings.

The investigation revealed the following: Regarding allegation: Resident sustained a pressure injury while in care. It is alleged R1 developed an unstageable wound due to neglect. Interviews with residents revealed staff ensure to provide care and assist those that are in bed.
(CONTINUED ON LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2025
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 28-AS-20250328145917
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: 10/25/2025
NARRATIVE
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Interviews conducted with staff revealed, R1 was receiving services from a home health agency. Per staff, they followed home health nurse’s recommendations, provided assistance to R1 by repositioned at least every two hours. Per staff, R1 was cognitive and would choose to sit in R1’s wheelchair daily to be able to move around. Interview conducted with responsible party revealed, responsible party visited the facility and had no concerns of neglect from the facility staff. Documents reviewed revealed, R1 was admitted to receive home health agency services on 3/3/25. Per home health records dated 3/3/25, R1 had a stage 2 wound to left buttock, and will be provided care by a skilled professional to perform wound care three times a week. Wound care order dated: 3/3/25 notes skill professional “to provide wound care to stage 2 pressure ulcer on left buttock.” Wound care order dated: 3/15/25 notes R1 was observed with a change in condition unrelated to the wound and send to the hospital. Per medical records R1 was admitted to the hospital on 3/15/25. Hospital assesses the wound on 3/16/25 as a stage 2 wound to the right buttocks and unstageable to the left buttocks. Although, the wound to the left buttocks was noted as unstageable on 3/16/25 R1 was receiving care by a skill professional under home health care since 3/3/25. Documents reviewed do not corroborate the allegation. Therefore, the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2