197608358-2-29-2024-28-AS-FFIS-D4KVC3-20240422161824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608358
Report Date: 02/29/2024
Date Signed: 02/29/2024 12:39:09 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
02/21/2024 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240221103052

FACILITY NAME:	LA POSADA IN SAN DIMAS		FACILITY NUMBER:	197608358
ADMINISTRATOR:	LUCY PARKER		FACILITY TYPE:	740
ADDRESS:	1452 GOLDRUSH STREET		TELEPHONE:	(909) 599-2273
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	6	CENSUS: 5	DATE:	02/29/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lucy Parker- Licensee		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Licensee did not ensure that facility maintained liability insurance coverage.

INVESTIGATION FINDINGS:

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Licensing Prorgam Analyst (LPA) V. Maldonado made an unannounced complaint visit at the facility for the purpose of investigating the above-mentioned allegation. LPA Maldonado met with Licensee, Lucy Parker, and Administrator, Lorraine Lopez, and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the resident and staff roster, a copy of resident facesheets for Residents#1-6 (R1-R6), and a copy of the facility's insurance policies for the year 2021-2024. LPA also conducted a tour of the physical plant with Administrator and conducted interviews with the Licensee and Administrator. A telephonic interview was also conducted with an insurance company respresentative to confirm information.

The investigation revealed the following:

(Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

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-20240221103052

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: LA POSADA IN SAN DIMAS	FACILITY NUMBER: 197608358
	VISIT DATE: 02/29/2024

NARRATIVE

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Regarding allegation: Licensee did not ensure that facility maintained liability insurance coverage.
It is alleged that the facility did not have an active liability insurance policy in the year 2021. Per interviews conducted with Licensee and Administrator, the allegation was denied. They stated the facility has had an active liability insurance policy since they were licensed, per the Licensing Department's requirements. Per the interview conducted with the insurance company representative, it was confirmed that the facility did hold an active liability insurance policy in the year 2021. After review of Liability Insurance records, LPA discovered that the facility has maintained the required coverage from 05/04/2020 through 05/15/2024 and has the required coverage as required by the Health and Safety Code, section 1569.605.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Per California Code of Regulations, Title 22, and Health and Safety Code, no deficiencies were observed or cited during today's visit.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/29/2024

LIC9099 (FAS) - (06/04)

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