191220719-12-1-2023-31-AS-MVAO-D4DTJ3-20240416144535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191220719
Report Date: 12/01/2023
Date Signed: 12/01/2023 02:50:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20231130094843

FACILITY NAME:	BRU FAMILY HOME #2		FACILITY NUMBER:	191220719
ADMINISTRATOR:	LUIS BRUI		FACILITY TYPE:	735
ADDRESS:	528 EAST AVENUE J-10		TELEPHONE:	(661) 949-6365
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 4	DATE:	12/01/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Bibiana Bru, Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff is withholding client's assistive device.
Staff are taking pictures of client.
Staff is forcing client to sign documents.

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analysts (LPA) Lorena Casillas and Angela Panushkina conducted an unannounced 24-hour complaint visit at this facility to investigate the above allegations. LPAs met with Lusia Pattriani (S1), who granted access to the facility. Administrator arrived shortly after, and LPAs explained the reason for the visit.

During course of the investigation, interviews and record reviews were made. At 10:10am, LPAs requested resident and staff roster. At 10:20am, LPAs requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan/IPP etc., relevant to the investigation. At approximately 10:30am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:40am – 12:20pm, LPA interviewed the Administrator, four (4) staff and three (3) out of four (4) clients, who were able to communicate.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

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 31-AS-20231130094843

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BRU FAMILY HOME #2	FACILITY NUMBER: 191220719
	VISIT DATE: 12/01/2023

NARRATIVE

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Allegation: Staff is withholding client's assistive device.
To investigate this allegation, LPAs conducted an interview with the Administrator and were informed that Client #1 (C1's) roommate has a tendency to take other clients items and in order to protect C1's cochlear device the staff offered to lock it in the file cabinet and provide it to C1 upon request. In addition, interviews with four (4) out of four (4) staff members revealed that they never withhold clients personal items/assistive devices. Lastly, LPAs interviewed three (3) out of four (4) clients, who were able to communicate and three (3) out of four (4) clients denied the allegation and reported staff never withheld any clients, including C1's assistive devise.

Allegation: Staff are taking pictures of client.
To investigate this allegation, LPAs conducted an interview with the Administrator and four (4) staff members. Administrator and three (3) staff members denied ever taking unwanted pictures of clients and or C1. Interview with S2 revealed that C1 would like to take a selfie and ask S2 to take pictures of him/her on his/her phone. Moreover, LPAs conducted interviews with three (3) out of four (4) clients, who were able to communicate, and all three (3) clients denied the above allegation and reported that staff would never take unwanted pictures of clients and or C1. In addition, all three (3) clients informed LPAs that all facility staff members are very nice, well trained and approach the clients in a very professional manner.

Allegation: Staff is forcing client to sign documents.
To investigate this allegation, LPAs conducted an interview with the Administrator and were informed that upon admission, all clients sign the facility documents. When discharged, the only form that the facility requires them to sign is the Resident Personal Property and Valuables (LIC621). Moreover, interviews with four (4) out of four (4) staff members revealed that they would never force clients to sign any documents. Lastly, interviews with three (3) out of four (4) clients confirmed that the facility staff will always provide information regarding the documents prior to being signed, and no staff ever forces them to sign anything. Based on inspection, observation and interviews there is no sufficient evidence to support the above three (3) allegations. Therefore, the allegations are Unsubstantiated at this time.

No deficiencies cited during todays visit.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2023

LIC9099 (FAS) - (06/04)

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