191500097-11-10-2021-28-AS-SCOL-CDERVC-20220412132117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191500097
Report Date: 11/10/2021
Date Signed: 11/10/2021 03:33:27 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, 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
08/24/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210824121342

FACILITY NAME:	BECKFORD WAY HOME		FACILITY NUMBER:	191500097
ADMINISTRATOR:	NICOLAS, ROSARIO G.		FACILITY TYPE:	735
ADDRESS:	1224 BECKFORD WAY		TELEPHONE:	(909) 621-2543
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	6	CENSUS: 4	DATE:	11/10/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Rosario Nicolas		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff inappropriately handled resident in care.

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the complaint investigation report created on 9/2/21. The reason for amendment is the initial report contained third party names with statements made by them which have been removed. No other changes have been made to the report.***

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Staff Wilfredo Cruz and explained the reason for the visit.

The investigation consisted of: LPA conducted a telephone interview with personnel of the placement agency at 10:00am, telephone interview with Administrator Rosario Nicolas at 10:15am, Staff 1-3 (S1-3) from 10:30am- 11:00am, Clients 1-4 (C1-4) from 11:00am - 11:30am. LPA reviewed C1's facility file and collected copies of

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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-20210824121342

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: BECKFORD WAY HOME	FACILITY NUMBER: 191500097
	VISIT DATE: 11/10/2021

NARRATIVE

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the following: Individual Program Plan (IPP), Physical Exam dated 7/19/21 and Medical Visit Information dates 8/16/21, 8/17/21 and 8/18/21. LPA also collected copies of Staff and Client Rosters. LPA observed four (4) clients in care during visit: One client was in the living room and three (3) clients were in the family room.

Investigation revealed the following: Regarding allegation, Staff inappropriately handled resident in care, it is alleged that facility staff pushed client. Interview with Administrator Nicolas revealed that staff have not inappropriately handled any client in care. She stated that none of her staff have pushed any facility client. She stated that facility staff treat all clients with dignity and respect. Interviews conducted with S1-3 revealed that they have never inappropriately handled or pushed any facility client. S1-3 stated that they treat all clients with dignity and respect. Administrator and S1 stated that C1 had recently exhibited a change in condition and also began fabricating stories. Interviews conducted with C3-4 revealed that they like living at the facility and stated that facility staff have not pushed them. LPA attempted to interview C1-2 but was unable to obtain relevant information. LPA additionally interviewed placement agency personnel and information obtained from them did not reveal any supportive evidence for the allegation. LPA observed four (4) clients in care during the visit and observed clients to appear calm and participating in individualized activities. LPA reviewed C1's IPP which revealed that client has a history of property destruction and fabricating incidents. LPA observed interactions between staff and clients and did not observe anything of concern and also observed staff tending to clients needs. Based on interviews conducted with facility administrator/ staff, facility clients, placement agency personnel, LPAs observations and review of documents there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Administrator Rosario Nicolas.

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

LIC9099 (FAS) - (06/04)

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