<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191502984
Report Date: 01/16/2024
Date Signed: 01/16/2024 10:48:09 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
01/11/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240111090141
FACILITY NAME:SOUTHSIDE MANORFACILITY NUMBER:
191502984
ADMINISTRATOR:JAMES (GARY) PARDUEFACILITY TYPE:
735
ADDRESS:820 EAST GRAND AVENUETELEPHONE:
(909) 623-7305
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:38CENSUS: 24DATE:
01/16/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Danelle Loboda/S-1 and Craig Pardue/S-2TIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for clients with scabies.
Staff made false statements regarding clients’ condition.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licesing Program Analyst (LPA) Elizabeth Irra conducted an unannounced visit to investigate the above allegations. LPA met with Danelle Loboda/S-1 and Craig Pardue/S-2 and discussed the purpose of today's visit.

During this visit, LPA obtained copies of the client and staff rosters, reviewed files for C-1 and C-2 and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Regional Center Service Coordinator for C-1 and C-2 and interviewed C-1 and C-2.

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: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
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 2
Control Number 28-AS-20240111090141
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: 01/16/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not seek medical attention for clients with scabies. Staff interviews revealed that C-1 nor C-2 have scabies. Staff interviews revealed that C-1 and C-2 have had routine prescribed medication (creams) to be administered twice daily to treat a skin condition (not scabies) for quite sometime. Staff interviews revealed that there are no clients with scabies at this facility. Staff interviews revealed that the primary doctor conducts visits monthly for routine medical consultations. C-1's and C-2's primary doctor was at this facility during today's visit and indicated that both C-1 and C-2 do not have scabies. Staff interviews also revealed that C-2 has a history of fabricating stories. Interviewed clients indicated staff provide them with cream daily to treat their skin condition (not scabies). Interviewed clients indicated they do not have scabies. Interviews and reviewed documentation do not corroborate this allegation.

Allegation: Staff made false statements regarding clients’ condition. Staff interviews revealed that staff do not make false statements regarding clients' condition. Interviewed staff indicated that C-1 and C-2 were kept home from their day program from 01/05/24 through 01/09/24 due to both having a cold. Per S-1, S-1 communicated with the day program the reason as to why C-1 and C-2 did not attend day program. Interviewed clients indicated they did not attend day program due to them having a cold. Interviews 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 Danelle Loboda/S-1
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2