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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801456
Report Date: 06/06/2023
Date Signed: 06/06/2023 01:17:40 PM

Substantiated


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
06/02/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230602115118
FACILITY NAME:FILIPINAS CARE HOMEFACILITY NUMBER:
197801456
ADMINISTRATOR:CORPUZ, DANIELFACILITY TYPE:
735
ADDRESS:18422 SEADLER DRTELEPHONE:
(626) 789-7157
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:6CENSUS: 5DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Administrator Daniel Corpuz TIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Staff did not ensure that residents had access to their personal belongings while in care.

Staff do not have required training.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) above. LPA met with Administrator Daniel Corpuz and the purpose of the visit was discussed.

During todays visit LPA Villalobos conducted the following: LPA interviewed Staff #1-#3 (S1-S3) and Clients #1-#3(C1-C3). LPA reviewed files for S1-S3 and C1-C2. LPA toured the physicals plant with administrator. LPA reviewed and collected copies of documents from C1-C2's file, Staff and client rosters, and reports from San Gabriel Pomona Regional Center . The investigation revealed the following:

In regards to the allegation "Staff did not ensure that residents had access to their personal belongings while in care." it was alleged that staff used magnet locks to prevent clients from accessing their personal belongings. (3) of (3) Staff interviewed denied the allegation...

Continued on 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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 3
Control Number 28-AS-20230602115118
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: FILIPINAS CARE HOME
FACILITY NUMBER: 197801456
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
85072(b)(8)
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85072 Personal Rights (b)The licensee shall insure that each client is accorded the following personal rights.(8) To have access to individual storage space for his/her private use.

This was not met as evidenced by:
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Magnet locks were removed by the time of visit. No further corrections needed.

POC cleared during the visit.
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Magnet locks were placed in C1's drawers preventing them access to their personal belongings. This poses a potential health and safety risk to clients in care and supervision
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Type B
06/09/2023
Section Cited
CCR
85065(f)
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85065 Personnel Requirements. (f) The licensee shall ensure that all direct services to clients requiring specialized skills are performed by personnel who are licensed or certified to perform the service..
This was not met as evidenced by:
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Administrator has enrolled all staff in training as of 6/1/23.

POC cleared at the time of visit.
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Staff CPI certificates expired on 9/25/20. This poses a potential health and safety risk to clients in care and supervision
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230602115118
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: FILIPINAS CARE HOME
FACILITY NUMBER: 197801456
VISIT DATE: 06/06/2023
NARRATIVE
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(3) of (3) Clients interviewed could not corroborate the allegation. Interviews with staff show that there were magnet locks used on C1's cabinets used overnight to mitigate C1's behavior of taking out clothing's and throwing them on the floor. Review of files does not show that the locks are part of a plan to meet C1's needs or approved by C1 placement agency. This shows the facility locked C1's belongings violating their personal rights. Based on LPA's interviews and files reviewed, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

In regards to the allegation "Staff do not have required training" it was alleged that staff do not have required CPI training to meet clients needs. (3) of (3) Staff interviewed denied the allegation. (3) of (3) Clients interviewed could not corroborate the allegation. Interviews show that staff have received CPI training in the past but the certificates expired. Review of files showed that the CPI certificates for staff expired 9/25/20. Due to the population of clients in care , staff are required by Clients placement agency to meet the requirement of active CPI training certificates. This shows the facility failed to maintain required training needed. Based on LPA's interviews and files reviewed, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

Exit interview held and a copy of the report and appeal rights was provided and discussed.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3