St. Sebastian's Home for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA met with Barbara Boiston, House Manager and explained the reason for the visit. The facility is approved to serve residents age range 60 and above, approved for six (6) non ambulatory residents in bedrooms 1 through 3. Bedroom #4 is for staff use only. Hospice waiver approved for (6) residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs prior to being around residents. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. LPA observed uncovered left over food in the refrigerator and food containers were not labeled. LPA also observed that the kitchen cabinet lock where cleaning supplies and chemicals are stored is broken. Due to time constraints, LPA will return at a later date for a continuation visit. LPA will complete the remaining domains: Operational Requirements, Physical Plant & Environment Safety, Staffing, Personal Records-Training, Resident Rights-Information, Planned Activities, Incidental M & D, Resident Records-Incident Reports, Disaster Preparedness, Residents with SHN. Exit Interview conducted and a copy of the report was provided to the House Manager, Barbara Boistonthe state’s words, verbatim · CDSS document, May 15, 2026

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection. LPA met with House Manager, Barbara Boiston and explained the purpose of the visit. The fire clearance is approved for six (6) non-ambulatory residents in bedrooms #1 - #3. Bedroom #4 is for staff use only. There is a hospice waiver approved for 6 residents. LPA inspected the facility using the Compliance and Regulatory Enforcement (CARE) tools. The facility is a single story home with 3 resident bedrooms, 1 staff room, 2 bathrooms, living room, dining room, laundry room, and kitchen. The spacious backyard has a shaded area. There is no swimming pool on the premises. Knives, sharps, and cleaning supplies are locked. The hot water temperature was measured between the required range of 105-120 degrees F. The facility has auditory devices at the exit doors. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. The kitchen is kept clean and sanitary. Smoke and carbon monoxide detectors are operational. The facility is continuing to follow their Infection Control plan. Staff are wearing gloves to assist residents. The facility has a dementia care plan to accept or retain residents with dementia. There are currently 6 residents residing at the facility.There is sufficient space to accommodate indoor and outdoor activities. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current. LPA reviewed 3 personnel files. Administrator's (Briana McGee) certificate expires on 11/19/25. Staff have current CPR & First Aid certificates. They are receiving on-going training. LPA reviewed 6 resident files and their medications. Files are complete and medications are given as prescribed. The Emergency Disaster Plan is reviewed annually and drills are being conducted. No deficiencies were issued. An exit interview was held and a copy of this report was given to B. Boiston.the state’s words, verbatim · CDSS document, Jun 5, 2025

Allegation investigated: . Questionable death. 2. Staff did not seek timely medical care for resident.

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegations listed above. LPA met with Administrator, Briana McGee, and explained the reason for the visit. The investigation consisted of the following: On 8/7/24, LPA Chan conducted the initial investigation and gathered documents pertaining to Resident #1 and Staff. LPA also toured the facility and observed sufficient food supplies. Subsequently, the Department of Social Services Investigations Bureau (IB) Investigator, Olivia Spindola, interviewed the facility staff, residents, and family members. Reports from the West Covina Police Department and the West Covina Fire Department were obtained and reviewed. (Continue on LIC9099C) Unsubstantiated The investigation revealed the following: Allegations – Questionable death and Staff did not seek timely medical care for resident. It was alleged that Resident #1 (R1) was unresponsive and possibly not breathing for approximately 40 minutes prior to 911 being called. IB Investigator Spindola interviewed the administrator, staff, and family member to determine findings. On 8/5/24 just before 7 am, R1 was discovered by facility staff cold to touch and not breathing. Staff contacted 911 after being instructed by the administrator. The West Covina Fire Department and Police Department arrived on scene and medical personnel performed CPR on R1. R1 was pronounced deceased at 7:26 am. Emergency personnel reports indicated that R1 was pulseless and there were no signs of foul play. It was also mentioned that the death appeared natural with no unusual markings or injuries. The police officer confirmed with the Deputy Coroner who advised the case was not a coroner case. Facility staff and R1’s family member stated that R1 had been in poor health in the days prior to the death. R1’s family took resident to the doctor on 8/1/24 and was told by the doctor that everything looked okay. Based on the reports and interviews gathered, R1’s death was not deemed questionable and Staff contacted 911 soon after discovering resident was not breathing. 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. An exit interview was conducted with Briana McGee. A copy of this report along with the appeal rights was provided.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 28-AS-20240805160859

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit to issue a deficiency found during a complaint investigation. LPA explained the reason to administrator, Briana McGee. During the visit, LPA measured the hot water temperature. The hot water was measured at 137.5 degrees F in the resident's common bathroom which is over the required range. A deficiency is issued on the LIC809D and a civil penalty for a repeated violation has been assessed. An exit interview was held. A copy of this report along with appeal rights was given to the administrator.the state’s words, verbatim · CDSS document, Aug 7, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Aug 8, 2024

(e) Water supplies and plumbing fixtures...(2) Faucets used by residents for personal care...shall deliver hot water. Hot water temperature controls shall be maintained ...not more than 120 degree F (49 degrees C).This requirement is not met as evidenced by: Based on observation, the hot water temperature was not maintained within the required range which poses an immediate health and safety concern for residents in care.the state’s words, verbatim · CDSS document, Aug 7, 2024

Plan of correction: The licensee shall submit plan to ensure the hot water temperature is within the 105-120 degrees F and also a log in which the hot water was measured for each shift. These items shall be submitted to LPA by 8/8/24.

Type of visit: POC

Licensing Program Analyst (LPA) Galarza conducted an Unannounced Plan Of Correction (POC) visit to follow up on the Plan of Correction bed rail citations issued during the 5.23.2024-annual inspection visit. The purpose of this visit was explained to Facility Administrator Briana McGee telephonically because access to the facility was not permitted because the facility entrance gate was closed. LPA called the facility and there was no answer. Administrator arrived shortly after. 87608(a)(5)(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. Licensee did not comply with the section cited above by having 1/2 rails on R1 & R2's beds without a physician's order, which posed an immediate health, safety or personal rights risk to persons in care. 87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. Licensee did not comply with the section cited above in that resident (R3) has full bed rails without being enrolled in hospice, which posed an immediate health, safety or personal rights risk to persons in care. ***The above POCs were cleared by visit. Observations: Resident (R1's) bed rail physician order was obtained on 5/26/2024, but it does not specify the order is for half bed rails. Administrator shall request a corrected physician order. Resident (R2) does not yet have a 1/2 bed rail physician order. No rails were observed on the bed today. Resident (R3's) bed did not have bed rails. A physician order for 1/2 bed rails was obtained on 5/31/2024, but it does not specify that the order is for 1/2 bed rails. Administrator stated that the 1/2 bed rails have not been delivered yet. Resident (R4's) bed had two half rails on 1 side of the bed. A physician order was obtained on 5/30/24. Administrator removed one of the half rails on the side that had 2 half rails installed. Exit interview was conducted with Administrator Briana McGee. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 4, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit. The purpose of the visit was explained to caregiver staff Feiby Angeli Estanislao. Administrator Briana McGee arrived shortly after. There are currently 6 elderly residents 60 years and older residing in the facility. The following 12 Care Compliance and Regulatory Enforcement (CARE) tool domains were utilized during the inspection. Infection Control: The facility has an Infection Control Plan. Supplies of Personal Protective Equipment (PPEs) were observed. A visitor sign-in sheet is in place. Operational Requirements: An Infection Control Plan has been added to the Plan of Operation. The facility has a Dementia Waiver in place and an approved Hospice Waiver for 6 residents. A fire clearance for 6 non-ambulatory residents in bedrooms #1 - #3. Bedroom #4 is for staff use only. Liability Insurance in the amount of ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current with an expiration date of 6/27/2024. An American Red Cross 1st Aid kit and manual are readily available. No Surety bond is in place. Facility does not handle resident monies. *Narrative continues next page. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of four (4) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, backyard basketball court, and detached garage. The facility has one (1) fully charged fire extinguisher. Smoke and carbon monoxide detectors are operational. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances were observed in the unlocked laundry room and the cabinet underneath the kitchen sink has a locking mechanism that is easily accessible to residents in care. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Residents (R1 & R2) had 1/2 bed rails without a physician order, and R3 had full bed rails without being enrolled in hospice. Resident (R1's) medications were observed unlocked on top of the side dresser. Roommate has Dementia. Staffing: A total of four (4) staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 11/19/2023. Recertification is pending approval. Four (4) staff files were reviewed. Proof of staff training, health clearance, 1st Aid/CPR training, and criminal background clearance was reviewed. Resident Records/Incident Reports: A total of six (6)resident files were reviewed. They contained admission agreements, Physician's Reports, TB clearance, Physician's Orders, medical consent, and medication records. None of the resident files had Appraisal Needs/Services Plans, and R1-R3 did not have physician orders for bed rails. RCFE complaint poster and Personal rights are posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Activities are individualized. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Three (3) residents have a physician order for a modified diet. Incident Medical and Dental: Three (3) centrally stored resident medications were reviewed to verify there is a 30-day supply of medications. Resident (R1) had unlocked medications in their room. Medical and dental transportation is provided by families. Disaster Preparedness: An Emergency and Disaster Plan is place. Disaster drill logs were not provided because they are off site. Residents with Special Health Needs: Two (2) residents are receiving hospice services. One (1) resident receives home health services. Postural support physician orders were not observed in all resident files. Full and half bed rails for mobility assistance were observed in all resident rooms; however residents (R1-R3) need physician's orders. No residents have prohibited health conditions. Appraisals are on file. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Briana McGee. A copy of the report and appeal rights will be emailed due to printing difficulties.the state’s words, verbatim · CDSS document, May 23, 2024

The state marks this report as 13 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.