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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191502984
Report Date: 07/18/2024
Date Signed: 07/18/2024 02:16:48 PM

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
05/17/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240517132616
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: 22DATE:
07/18/2024
ANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Craig PardueTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Clients sustained unexplained injuries while in care
Staff smoke marijuana in the facility premises
Staff did not ensure facility was kept free of bedbugs
Staff yelled at client in care
Staff handled client in a rough manner
Staff did not provide client in care a new mattress
Staff forced client to eat their meal
Staff did not provide proper medication assistance to client's in care.
Staff did not provide comfortable accommodations to clients in care.
Conduct inimical.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Craig Pardue and discussed the purpose of today’s visit.

On 05/21/24, LPA Irra conducted the initial investigation. During this visit, LPA obtained a copy of the staff and client rosters and reviewed files for Client #1 (C-1) through Client #7 (C-7) and files for Staff #1 (S-1) through Staff #7 (S-7) and obtained relevant documentation. LPA interviewed S-1, S-2, S-4 and S-6. LPA was unable to interview S-3 and S-5 as they were not present at the time of this visit. S-7 is no longer working at this facility. LPA was unable to interview C-1, C-2, C-3, C-5 and C-6 as they were not present at the time of this visit. C-4 and C-7 no longer reside at this facility.

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: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 4
Control Number 28-AS-20240517132616
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: 07/18/2024
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
During the course of this investigation, LPA also interviewed S-3 and C-1, C-2, C-5, C-6, and C-8. C-3 refused to be interviewed. LPA attempted to reach S-5 and was unsuccessful. LPA reviewed information provided by Pomona Police Department. LPA also toured this facility.

Allegation: Clients sustained unexplained injuries while in care. It is alleged that C-1 through C-3 had marks/bruising on their body of unknown origin. Staff interviews revealed that C-1 had a bruise on the right arm due to an injection C-1 received. Per staff interviews, C-1 was taken to urgent care for treatment. Staff interviews revealed that they have not observed C-2 nor C-3 to have any bruises. On 05/18/24, Pomona Police Department also conducted a welfare check and there were no signs of bruising and that the clients felt safe (report/case was closed). Interviewed clients revealed that they have not had bruises nor have seen other clients with bruises. Interviews conducted and Pomona Police Department findings do not corroborate this allegation.



Allegation: Staff smoke marijuana in the facility premises It is alleged that staff smoke marijuana during their shift in the facility premises. Staff interviews revealed that staff do not smoke in the facility premises. Interviewed staff indicated there are clients that smoke cigarettes outside in the designated smoking section. Interviewed staff indicated they have not witnessed nor received any complaints pertaining to this matter. Client interviews revealed that staff do not smoke in the facility premises. Interviewed clients indicated there are clients that do smoke outside in the designated area. Interviewed clients indicated they have no concerns pertaining to this matter. Interviews do not corroborate this allegation.

Allegation: Staff did not ensure facility was kept free of bedbugs. It is alleged that the facility has a bed bug infestation. Staff interviews revealed that the facility does not have bedbugs. Interviewed staff indicated they have not observed nor received any complaints in regards to this matter. Client interviews revealed that the facility does not have bed bugs. Interviewed clients have not heard anyone complaining about this matter. LPA conducted a tour of the facility and did not observe any bedbugs. Interviews and tour do not corroborate this allegation.

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

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20240517132616
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: 07/18/2024
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 yelled at client in care It is alleged that S-1 yelled at C-4 to open their door when housekeeping needed to enter C-4’s bedroom. Staff interviews revealed that staff do not yell at clients. Interviewed staff have not observed any staff (including S-1) yelling at clients (including C-4). Interviewed staff indicated they have not received any concerns/complaints pertaining to this matter. Client interviews revealed that staff do not yell at clients. Interviewed clients indicated they have not heard anyone complaining about this matter. Interviews do not corroborate this allegation.

Allegation: Staff handled client in a rough manner. It is alleged that S-1 grabbed C-4 by the shirt and forcefully sat C-4 on the dining chair. Staff interviews revealed that staff do not handle clients in a rough manner (including grabbing clients by their shirts and forcefully sitting clients down). Interviewed staff have not observed any staff (including S-1) handling clients (including C-4) in a rough manner. Interviewed staff indicated they have not received any concerns/complaints pertaining to this matter. Client interviews revealed that staff do not handle clients in a rough manner. Interviewed clients indicated they have not heard anyone complaining about this matter. Interviews do not corroborate this allegation.

Allegation: Staff did not provide client in care a new mattress It is alleged that C-5’s mattress had a coil protruding out of the mattress. Staff interviews revealed that mattresses (including C-5) are in good condition. Interviewed staff indicated that they have not received any concerns/complaints pertaining to this matter. Client interviews revealed that their mattresses are in good condition and have no concerns. Interviewed clients indicated they have not heard anyone complaining about this matter. Interviews and tour do not corroborate this allegation.

Allegation: Staff forced client to eat their meal It is alleged that S-5 forced C-6 to drink water and eat a soup. Staff interviews revealed that staff do not force clients to eat their meals nor drink water. Interviewed staff indicated they have not witnessed any staff forcing clients to eat nor drink water (including S-5 and C-6). Interviewed staff indicated they have not received any concerns/complaints pertaining to this matter. Client interviews revealed that staff do not force clients to eat their meal nor drink water. Interviewed clients indicated they have not heard anyone complaining about this matter. Interviews do not corroborate this allegation.

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

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240517132616
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: 07/18/2024
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 provide proper medication assistance to client's in care. It is alleged that medication pills have been observed to be on the floor and staff disregard the issue. It is also alleged that staff are missing client’s medication times and that clients do not receive their medication and that staff do not document any medication errors. Staff interviews revealed that medication pills have not been observed to be on the floor. Staff interviews also revealed that clients are provided with their medication as prescribed. Interviewed staff have not received any concerns/complaints pertaining to this matter. Client interviews revealed that staff provide them with their medications on a daily basis. Interviewed clients indicated they have not observed any medication pills on the floor. Interviewed clients indicated they do not have any concerns. Interviews do not corroborate this allegation.

Staff did not provide comfortable accommodations to clients in care. It is alleged that the facility had to go through renovations and clients were present during the construction and that clients were exposed to dust. Staff interviews revealed that section #4 of the property underwent emergency plumbing repair in February 2024. Interviewed staff indicated the facility has not gone through renovations and that clients were relocated to vacant rooms during the plumbing repair. Per staff interviews, clients were not exposed to dust. Interviewed staff indicated they have not received any complaints/concerns pertaining to this matter. Interviewed clients do not recall an emergency plumbing repair taking place. Interviewed clients indicated that the facility has not gone through renovations. Interviews do not corroborate this allegation.

Conduct inimical. It is alleged that on 04/20/24, a random adult came near the facility premises and ran into the property and that the property owner got their gun out and shot two rounds into the air. Staff interviews revealed that they have not witnessed any random adult coming near the facility premises and running into the property nor the property owner using a gun and shooting into the air. Interviewed staff indicated they have not received any concerns/complaints pertaining to this matter. Interviewed clients indicated they have not witnessed nor heard anyone talking about such incident. Interviewed clients indicated they feel safe residing at this facility. Interviews do not corroborate this 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, copy of report and Appeal Rights were provided to Craig Pardue.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4