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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603410
Report Date: 09/24/2024
Date Signed: 09/24/2024 02:13:17 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
04/02/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240402153426
FACILITY NAME:LA CASITA RESIDENTIAL CARE INC.FACILITY NUMBER:
198603410
ADMINISTRATOR:SANTAMARIA, HUMBERTOFACILITY TYPE:
740
ADDRESS:700 N. GRAND AVE.TELEPHONE:
(626) 387-9987
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY:6CENSUS: 6DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Humberto Santamaria, Administrator TIME COMPLETED:
02:21 PM
ALLEGATION(S):
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Questionable Death.
Staff abandon resident.
Staff are unable to communicate with resident due to language barrier.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made subsequent visit to investigate the above allegations. LPA met with Humberto Santamaria, Administrator and discussed the purpose of the visit.

04/03/24
Investigation consisted of the following: LPA Lopez requested a copy of the Staff and Resident roster, and conducted a tour of facility bedrooms, bathrooms, and common areas. LPA also reviewed and obtained files for Resident (R#1). LPA observed the residents in the facility to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did observe several Health and/or Safety concerns. LPA addressed those concerns on a Case Management report. It has been determined that the above-mentioned allegations will require further investigation.

(continued on 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
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 3
Control Number 28-AS-20240402153426
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: LA CASITA RESIDENTIAL CARE INC.
FACILITY NUMBER: 198603410
VISIT DATE: 09/24/2024
NARRATIVE
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The investigation consisted of LPA taking tour of facility, interviews with two (2) facility residents, Five (5) staff of the facility, two witnesses (W#1 W#2) and the department interviewed home health nurses.

The investigation revealed:

Allegation: Questionable Death. It is alleged that facility neglected and did not provide care to resident resulting in resident being admitted to hospital and passing at the hospital.

No neglect was reported by the persons interviewed. Five (5) of five (5) staff interviewed denied the allegations and reported sending the victim to the hospital for medical assessment due to nausea/vomiting on 01/06/2024. R1 passed away on 01/23/2024 at the hospital due to complications. Two (2) of two (2) residents interviewed could not corroborate the allegation. Review of R1 Home Health records did not uncover any neglect concerns. No abuse or neglect concerns noted in resident's hospital records. The information and evidence obtained did not sufficiently support the allegation.

Allegation: Staff abandon resident. It is alleged that staff took resident to hospital on 01/06/2024 and left resident there, abandoning resident.

Five (5) of (5) staff denied the allegation. Two (2) of two (2) residents could not corroborate the allegation.

S1 stated that S1 took resident to hospital on the request of daughter after staff discussed change of condition with daughter.

S1 stated that daughter stated she would meet S1 at hospital with resident. S1 stated daughter called S1 to informed S1 that daughter was at emergency door and S1 stated that he gave resident to daughter and left the hospital.

S2, who is spouse of S1 stated that the facility called daughter about taking resident to hospital and that daughter told facility staff that she was tending to her cat and that was more important to her. S2 stated S1 left resident with nurse at the hospital entrance and stated that daughter had not yet arrived.

There are inconsistencies in the statements of S1 and S2, however, no report of abandonment was sent by hospital and there is not enough information or evidence that staff abandoned resident at hospital.

(continued) .

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240402153426
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: LA CASITA RESIDENTIAL CARE INC.
FACILITY NUMBER: 198603410
VISIT DATE: 09/24/2024
NARRATIVE
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Allegation: Staff are unable to communicate with resident due to language barrier. It is alleged that facility staff do not speak or understand English and that makes it difficult to communicate.

Five (5) of five (5) staff denied the allegation. Two (2) of two (2) residents could not corroborate the allegation. S1 stated that staff understand simple commands. S2 stated that the allegation is not true. S2 stated they live close and that the caregivers meet all the needs of the residents. S3 who was working at facility previously stated she understands English but prefers Spanish. S3 stated S3 met all the needs of residents when S3 was working at facility. S4 stated S4 really does not understand English too well but enough to be able to meet the resident’s needs. S5 stated S5 is new to facility and is able to meet the needs of the residents. LPA interviewed five (5) staff in English and four (4) of five (5) staff were able to answer questions. LPA was present during meal time and 3 residents were served different food, when asked S4 why, S4 explained that one resident is vegetarian and the prefer different meals. The residents appeared clean and well taken care off. The staff present is competent to meet the needs of all the residents currently. There is not enough information or evidence to proof this allegation.

Based on statements and interviews conducted, review of residents files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, copy of report and appeal rights provided

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3