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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801934
Report Date: 02/02/2023
Date Signed: 02/02/2023 11:56:20 AM

Substantiated


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
01/27/2023 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230127104851
FACILITY NAME:COLE VOCATIONAL SERVICES COVINA 2FACILITY NUMBER:
197801934
ADMINISTRATOR:MATT PORPORAFACILITY TYPE:
775
ADDRESS:515 S 2ND AVETELEPHONE:
(626) 915-6678
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY:45CENSUS: 14DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Miriam Maldonado TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff spoke inappropriately to client in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Christine Wong and Tena Herrera conducted an initial 10 days complaint visit and investigate the above allegation. LPA met with Program Supervisor, Maya Henley and explained the reason of the visit. Shortly after, the program director Miriam Maldonado arrived and assisted with the visit.

The investigation consisted of the following: LPAs interviewed the program director, two clients (C1-C2) and two staff (S1-S2) at the community based program, and two staff (S3-S4) via telephone. LPA also obtained the in service training about preventing abuse dated on 7/27/22.

The investigation revealed of the following: In regard to the allegation of "Staff spoke inappropriately to client in care" LPA interviewed two clients and two out of two were reported staff were yelled and speak inappropriately to the clients. LPA interviewed staff and reported staff did raise the voice to clients and yelled at clients.
(See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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-20230127104851
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: COLE VOCATIONAL SERVICES COVINA 2
FACILITY NUMBER: 197801934
VISIT DATE: 02/02/2023
NARRATIVE
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Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met, therefore the allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 3 are being cited on the attached LIC 9099D.

Exit interview held and a copy of the report and appeal rights was provided to the Program Director Miriam Mimi Maldonado
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230127104851
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: COLE VOCATIONAL SERVICES COVINA 2
FACILITY NUMBER: 197801934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/16/2023
Section Cited
CCR
82072(a)(3)
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82072 Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons.

The requirement is not met as evidenced by:
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The administrator will ensure each client shall have personal right which accorded dignity in his/her personal relationship with staff and other person. The administrator will retrain the staff about personal right and will send the staff training log to LPA by POC due date.
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LPAs interviews with clients and staff and reported staff cursed and yelled at clients which posed a potential risk to client in care.
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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3