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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600265
Report Date: 08/19/2025
Date Signed: 08/19/2025 12:34:14 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
07/07/2025 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20250707082330
FACILITY NAME:ERNIE'S PLACEFACILITY NUMBER:
198600265
ADMINISTRATOR:GARCIA, NOEYFACILITY TYPE:
735
ADDRESS:630 N. NICHOLSONTELEPHONE:
(626) 280-7205
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91755
CAPACITY:6CENSUS: 4DATE:
08/19/2025
UNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Marisol Alvarez, Med-Tech. TIME COMPLETED:
12:36 PM
ALLEGATION(S):
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Staff did not follow physicians orders
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made a subseqent visit to correct citation, this report supersedes all other previous reports and nothing else has changed, the finding remain the same. LPA met with Marisol Alvarez and discussed the purpose of the visit.
Licensing Program Analyst (LPA) Alberto Lopez made an initial 10-day visit to investigate the above allegation. LPA met with Alex Stott, Acting Administrator, and discussed the purpose of the visit.

The investigation consisted of LPA taking a tour of facility, interviewing five (5) (staff S#1-#5) two (2) clients,(C#1-C#2), obtaining, and reviewing C1 hospital discharge paperwork dated 09/24/2024, C1 Physicians report dated 09/23/2024, Incident report dated 09/25//2024, S#5 training record. C1 Medication Administration Record (MAR), and obtaining and reviewing staff and client rosters.

The Investigation revealed, Allegation: Staff did not follow physicians orders. It is alleged that facility administered PM medication in the AM for C1. (continued on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
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-20250707082330
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: ERNIE'S PLACE
FACILITY NUMBER: 198600265
VISIT DATE: 08/19/2025
NARRATIVE
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(continued from 9099)
LPA interviewed four (4) staff, and all four (4) staff admitted that PM medication was administered to C1 in the AM which is not physicians order. One staff member was on vacation and LPA was not able to interview staff. (continued on 9099C)

LPA interviewed two (2) clients and one client stated all medications are administered as ordered. C1 did not recall the incident. Three (3) clients were not able to answer questions due to cognitive impairment. LPA reviewed Regional Center Corrective Action Plan (CAP) and MAR and both show that the facility did not follow Physician's orders on 09/24/2024. Facility called 911 and C1 was transported to emergency room and returned to facility the same day. There is sufficient evidence to substantiate this allegation.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated.

Deficiencies are cited on the attached LIC9099D.

Exit interview held. A copy of the report, 9099D and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250707082330
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: ERNIE'S PLACE
FACILITY NUMBER: 198600265
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2025
Section Cited
CCR
80075(b)
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Health Related Services. Medications shall be given according to physician's directions.

This requirement is not met as evidenced by:
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Facility will conduct in-service on administration of medications for all staff that administer medication and will create a written plan explaining how facility will make sure medications are administered following physicians orders and how often training will be conducted with staff.
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C1 was administered PM medication in the AM which did not follow physicians orders which posed a potential health and safety or personal rights risk to persons 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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3