197606257-12-22-2023-29-AS-DPEA-CZXUJ6-20240129143701

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606257
Report Date: 12/22/2023
Date Signed: 12/22/2023 03:11:48 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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/22/2022 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20220322085804

FACILITY NAME:	EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE		FACILITY NUMBER:	197606257
ADMINISTRATOR:	VEGA TAPIA, DANNY		FACILITY TYPE:	735
ADDRESS:	7306 PASO ROBLES AVE		TELEPHONE:	(818) 609-8227
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY:	3	CENSUS: 1	DATE:	12/22/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Melky Flores		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident sustained an injury while in care
Staff did not seek medical care for resident in a timely manner
Staff do not allow resident access to personal belongings
Staff inappropriately manages resident's behaviors
Staff left resident in the restroom for a prolonged period
Staff mishandled clients' grocery funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint visit to deliver final findings for the allegation listed above. During today’s visit, LPA met with Melky Flores and explained the reason for the visit.

On 03/22/2022, from 2:15 p.m. – 4:00 p.m., LPA initiated an unannounced complaint investigation for the allegations listed above. During the visit, LPA toured the physical plant, interviewed staff, residents and reviewed and obtained pertinent documents relevant to the investigation. On 12/01/2023, from 12:45 p.m. – 3:30 p.m., LPA conducted a subsequent complaint visit. During the visit, LPA toured physical plant, interviewed staff, and reviewed and obtained copies of additional documentation relevant to the investigation. On 12/19/2023, LPA interviewed North Los Angeles Regional Center (NLARC) Quality Assurance Specialist (QAS).

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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 29-AS-20220322085804

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE	FACILITY NUMBER: 197606257
	VISIT DATE: 12/22/2023

NARRATIVE

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Continued from 9099
It was reported that Resident #1 (R1), sustained an injury while in care, as it was alleged, that Staff #1 (S1), used a gait belt on R1, which resulted in R1 sustaining “broken ribs”. The Reporting Party (RP) was anonymous, and no further details were provided. Interviews and records review reflected that R1 would only use a gait belt during physical therapy sessions with their therapist. Interviews conducted with eight (8) staff members further revealed that all have not observed any staff use a gait belt to assist with ambulation for any resident at this time.
Additionally, similar allegations pertaining to this incident were investigated by the Department previously (Complaint Control # 29-AS-20200908142229). Based on the investigation, R1 had healing fractures on R1’s rib cage. During that investigation it was revealed R1 has a health history including osteoporosis, edema and unsteady gait. R1 ambulated independently. On 09/06/2020, R1 got up to use the restroom and began to fall. Staff intervened, lowering R1 to the ground. Facility staff called 9-1-1, and paramedics came and took R1 for treatment at the hospital. Although facility staff informed paramedics of the fall, this information was not immediately relayed to hospital staff. During R1’s hospitalization on 09/06/2020, R1 was solely treated for edema and subsequently discharged on the same day. On 09/07/2020, facility staff noticed R1, who is non-verbal, to be in pain and unable to stand. Staff immediately called 9-1-1 and R1 was taken to the hospital, where R1 was diagnosed with a broken femur. Medical professionals interviewed indicated that the injuries R1 sustained are consistent with a fall. Los Angeles Police Department (LAPD) investigated the incident and indicated R1’s injuries are consistent with a fall. Based on information obtained over the course of the investigation, the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “R1 sustained an injury while in care” has been deemed Unsubstantiated at this time.

It was reported that staff did not seek medical care for R1 in a timely manner, as it was alleged that R1 became sick, but was not given timely medical attention. RP is anonymous; therefore, LPA was unable to confirm the date and time when R1 became sick and did not receive timely medical attention. However, interviews and records review revealed on 10/16/2021, an Unusual/Serious Incident Report (SIR) was received by the department, which indicated R1 displayed low oxygen levels and 9-1-1 was called. R1 was later diagnosed with Pneumonia. LPA’s interview with eight (8) staff revealed all staff have observed that if any resident displays any cold or flu like symptom, they check their vitals, inform Administrator then contact medical services, if necessary.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220322085804

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE	FACILITY NUMBER: 197606257
	VISIT DATE: 12/22/2023

NARRATIVE

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Continued from 9099-C

Interview with QAS, revealed they have never had concerns about their clients not receiving timely medical attention and they did not express any potential or immediate concerns of any client not receiving timely medical attention at this time. Based on information obtained over the course of the investigation, the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff did not seek medical care for R1 in a timely manner” has been deemed Unsubstantiated at this time.

It was reported that staff do not allow resident access to personal belongings, as it was alleged that S1, had confiscated Resident #2 (R2)’s personal belongings and locked them in an empty room. Interviews conducted with eight (8) staff reviewed revealed that no staff have ever observed any of R2’s personal items locked away in a room. During the physical plant conducted on 03/22/2022 and 12/01/2023, LPA did not observe any items belonging to R2 in the two (2) empty rooms. Interview with QAS, revealed no client has ever expressed any immediate or potential concerns of not having access to their personal belongings at this time. On 3-22-2022, LPA attempted to interview R2 but was unable due to R2 being non-verbal. Interviews conducted with other residents on 3-22-2022, did not reflect any concerns. Based on information obtained over the course of the investigation the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that “Staff do not allow resident access to personal belongings” has been deemed Unsubstantiated at this time.

It was reported that staff inappropriately manages resident’s behaviors, as it was alleged that S1 locks R2 out in the patio to control their behavior. Interviews conducted with eight (8) staff revealed that each staff have never observed R2 locked outside in the patio. Interview with QAS revealed no client has ever expressed any immediate or potential concerns of being locked in the patio. During the physical plant conducted on 03/22/2022, LPA observed R2 enter and exit the patio multiple times as R2 frequently sits in the shaded area outside. On 3-22-2022, LPA attempted to interview R2 but was unable due to R2 being non-verbal. Interviews conducted with other residents on 3-22-2022, not reflect any concerns. Based on information obtained over the course of the investigation, the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that Staff inappropriately manages resident’s behaviors” has been deemed Unsubstantiated at this time.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20220322085804

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE	FACILITY NUMBER: 197606257
	VISIT DATE: 12/22/2023

NARRATIVE

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Continued from 9099-C

It was reported that Staff left resident in the restroom for a prolonged period, as it was alleged that S1 would leave R1 on the toilet. Interviews conducted with eight (8) staff, revealed that typically they would assist residents to the restroom and wait right outside of the restroom until the resident stated they were finished. Each member of staff interviewed further revealed that each have not observed any client being left in the toilet for a prolonged period. Interview with QAS revealed that no client has ever expressed any immediate or potential concerns of being left in the restroom for a prolonged period. Interviews conducted with residents on 3-22-2022, did not reflect any concerns Based on information obtained over the course of the investigation, the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that Staff left resident in the restroom for a prolonged period has been deemed Unsubstantiated at this time.

It was reported Staff mishandled clients’ grocery funds, as it was alleged that S1 would use resident’s funds to purchase their own groceries. Interviews conducted and records review revealed S1 was never in charge of purchasing groceries. Interviews with eight (8) staff further revealed that a lot of staff bring in their lunch and label it with their name. No staff has ever observed S1’s name labeled on any groceries. Name would be labeled on containers brought from home or lunch boxes. Based on information obtained over the course of the investigation, the department does not have sufficient evidence to confirm this allegation occurred. Therefore, the allegation that Staff mishandled client’s grocer funds has been deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

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