191502984-9-26-2023-28-AS-TVAO-CWGQSB-20231010122516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191502984
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:43:10 AM

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
09/21/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230921153932

FACILITY NAME:	SOUTHSIDE MANOR		FACILITY NUMBER:	191502984
ADMINISTRATOR:	JAMES (GARY) PARDUE		FACILITY TYPE:	735
ADDRESS:	820 EAST GRAND AVENUE		TELEPHONE:	(909) 623-7305
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	38	CENSUS: 23	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Craig Pardue		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff inappropriately handled a client in care.
Staff yelled at a client in care.
Staff inappropriately disciplined a client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegations. LPA met with Craig Pardue and explained the purpose of today's visit.

During today's visit, LPA obtained copies of the staff and client rosters, reviewed file for Client #1 (C-1) and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #4 (S-4) and interviewed Client #2 (C-2) and Client #3 (C-3). Client #4 (C-4) refused to be interviewed. LPA attempted to interview Client #1 (C-1) via telephone and was unsuccessful. LPA also interviewed C-1’s Service Coordinator (SC) from San Gabriel Pomona Regional Center. Per SC, San Gabriel Pomona Regional Center investigated and determined the finding for these allegations to be unsubstantiated due to C-1’s “inconsistencies” of C-1’s stories.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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 28-AS-20230921153932

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: SOUTHSIDE MANOR	FACILITY NUMBER: 191502984
	VISIT DATE: 09/26/2023

NARRATIVE

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Allegation: Staff inappropriately handled a client in care. Staff interviews revealed that staff are not physically aggressive towards any clients. Staff interviews revealed that they have not witnessed S-1 “cupped C-1’s chin with S-1’s fingers”. Interviewed staff indicated they are trained in mandated reporting, client rights and zero tolerance. Interviewed clients revealed that staff do not handle clients inappropriately. Per client interviews, staff are not physically aggressive towards clients. Interviews do not corroborate this allegation.

Allegation: Staff yelled at a client in care. Staff interviews revealed that staff do not yell at any clients. Staff interviews revealed that staff have not witnessed any staff yelling at clients. Interviewed staff indicated they are trained in mandated reporting, client rights and zero tolerance. Interviewed clients revealed that staff do not yell at clients. Interviews do not corroborate this allegation.

Allegation: Staff inappropriately disciplined a client in care. Staff interviews revealed staff do not prohibit clients from watching TV or playing video games. Interviewed staff indicated that there are no video games and/or video games consoles for community/sharing amongst clients (clients have their own video games). Staff interviews revealed that C-1 does not own/have any video games (including gaming consoles) and has a TV inside C-1’s room. C-1’s inventory list reflects the TV and does not have any video games listed. Per staff interviews, staff have not removed any video games nor TV’s from any client rooms. Client interviews revealed that staff do not take any of their belongings which may also include any video games and/or TV’s. Interviews conducted do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Craig Pardue.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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