197801934-8-4-2023-28-AS-DSIS-CUQNME-20230815103457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801934
Report Date: 08/04/2023
Date Signed: 08/04/2023 03:02:32 PM

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
09/30/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220930143019

FACILITY NAME:	COLE VOCATIONAL SERVICES COVINA 2		FACILITY NUMBER:	197801934
ADMINISTRATOR:	MATT PORPORA		FACILITY TYPE:	775
ADDRESS:	515 S 2ND AVE		TELEPHONE:	(626) 915-6678
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	45	CENSUS: 42	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Miriam Maldonado - Program Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff member did not adequately supervise client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation into the allegation listed above. LPA met with Program Director Miriam Maldonado and explained the reason for the visit.

The investigation revealed the following: during the initial visit conducted on 10/06/2022, LPA Kruz Long obtained a copy of the Staff/Client rosters, Individual Program Plan and Individual Service Plan and Program Schedule for Client #1 (C1), and interviewed a staff member in the Zen Room. During today's visit, LPA Zaragoza interviewed Clients #3 - 6, (C3, C4, C5, C6), Staff #2 - 4 (S2, S3, S4). LPA also obtained copies of the following documentation: Current Client and Staff rosters, the Individual Service Plans of C1 and C2, the program scheule for this current week and the following week, and the facility's incident reports related to the incident. LPA interviewed Client #2 (C2) over the phone, and spoke with Client #1's (C1) facility administrator over the phone regarding the allegation becuase C1 is non-verbal. LPA called Staff #1 (S1) over the phone however S1 hung up and refused to be interviewed.

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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-20220930143019

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: 08/04/2023

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Staff member did not adequately supervise client while in care", it is alleged that S1 was assigned to pick up both C1 and C2 from their homes between the dates of 9/12/2022 - 9/21/2022 and take them to their day program at Mount San Antonio College for day program, however instead of doing so S1 took them to S1's own house. During interviews around the time of the incident, C2 expressed that they did not go to school as intended and that they instead went to a residential area where C2 and C1 sat on the front yard of a house believed to be S1's before being taken back to their respective homes. C1 is non-verbal however the administrator of C1's home corroborated the allegation and explained that when asking C1 about his whereabouts between the dates of 9/12/2022 - 9/21/2022, C1 shook C1's head "no" when asked if he went to school and "yes" if he went to a home instead. During the interview with Director, the facility conducted their own investigation into the incident, and their internal investigation matched up with C1 and C2's allegations. Miriam stated that after bringing up the allegation with S1, S1 subsequently resigned. During interviews at the facility with C3 - C6, none of the clients had any knowledge of the incident or heard of any clients being taken to any staff worker's home instead of program. Interviews with S2 - S3 revealed that neither had spoken with S1 in the past and had not heard of any similar incident occurring within the facility. Additionally, the San Gabriel/Pomona Regional Center conducted their own investigation into the allegation that S1 had not followed the activity calendar for C1 and C2 and instead took them to S1's own home, and their investigation was substantiated. Although it was determined that the facility staff member did not adequately supervise the clients while in care, there was no evidence indicating that C1 an C2 were left unsupervised during the incident.

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 LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the Program Director Miriam Maldonado.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220930143019

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: 08/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/05/2023 Section Cited CCR 82078(a)	1 2 3 4 5 6 7	82078 Responsibility for Providing Care and Superivision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement.	1 2 3 4 5 6 7	The administrator shall ensure that all adequate care and supervision will be provided by all staff to the clients. The administrator will retrain staff on providing adequate supervision and personal rights and will submit a copy of sing in sheet for all staff that recieved in-service training as well as copies of training materials that were discussed by the POC due date.
	8 9 10 11 12 13 14	The requirement is not met as evidenced by: Based on interviews conducted with clients and staff, LPA determined that C1 and C2 were not adequately supervised by S1, which posed an immediate risk for clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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