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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600265
Report Date: 02/27/2025
Date Signed: 02/27/2025 04:11:43 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
02/19/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250219122130
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: 6DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Noey Garcia and Karen Gazcon, AdministratorTIME COMPLETED:
04:19 PM
ALLEGATION(S):
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Staff did not treat resident with respect.
Staff threw object at resident, hitting resident.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alberto Lopez and Blanca Gonzalez made initial visit to investigate the allegations listed above. LPAs arrived unannounced and met with Yvonne Foster Staff and Noey Garcia Administrator arrived a short time later. The purpose of the visit was explained.

The investigation consisted of the following:
LPAs interviewed Six (6) staff (S#1– S#6) and one (1) client (C#1), reviewed, and obtained staff and client roster, and email regarding S5 previous concerns dated 02/05/2025 and Copy of Monterey Park Police incident number.
The investigation revealed: Allegation: Staff did not treat resident with respect. It is alleged that staff yelled and antagonized client on 02/14/2025

(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: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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-20250219122130
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: 02/27/2025
NARRATIVE
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(continued from 9099)

LPAs interviewed six (6) staff and five (5) of six (6) staff were able to corroborate the allegation. LPAs interviewed C1 and client stated that S5 was loud, and that C1 threw helmet at S5. On 02/14/2025, around 7:40PM S5 was preparing to administer medication when C1 asked for C1 medication. S5 told client that S5 will provide to client now. At the same time Client went to use restroom and S5 began to administer medication to other clients at facility. C1 came out of restroom and notice that S5 was administering medications to other clients and became irate due to not getting medication before the other clients and pushed the medication room door violently. C1 went back to C1 room and S5 followed and C1 then told S5 that C1 was going to kill S5 and S5 responded by yelling at C1 and telling C1 to do it, while standing by C1 door and telling C1 would go to jail. S5 was yelling and antagonizing C1 during this incident. S5 admitted to LPAs that S5 was yelling and inappropriate to C1 and stated S5 was regretful and stated S5 apologized to client. S5 last worked on 02/14/2025 and has since been terminated. There is sufficient evidence to substantiate this allegation.

Allegation: Staff threw object at resident, hitting resident. It is alleged that staff threw slipper at client during an argument and struck client in the back.

LPAs interviewed six (6) staff and five (5) of six (6) staff were able to corroborate the allegation. LPAs interviewed C1 and client stated that S5 was loud, and that client threw helmet at S5. On 02/14/2025, around 7:40PM S5 was preparing to administer medication when C1 asked for C1 medication. S5 told client that S5 will provide to C1 now. At the same time Client went to use restroom and S5 began to administer medication to other clients at facility. C1 came out of restroom and notice that S5 was administering medications to other clients and became irate due to not getting medication before the other clients and pushed the medication room door violently. C1 went to C1 room, and S5 followed. C1 told S5 that C1 was going to kill S5 and S5 responded by yelling at C1 and telling C1 to do it, while standing by C1 door and telling C1 would go to jail. S5 was yelling and antagonizing C1 during this incident. During the argument C1 threw C1 slipper at S5 and struck S5 on S5 face. S5 stated S5 pick up the slipper and threw it back at C1 and hit C1 in the back. S5 stated S5 regretted S5 action immediately and apologized to C1. S5 stated S5 was remorseful and understood S5 actions were wrong. There is sufficient evidence to substantiate this allegation.

Based on LPA's interviews and records reviewed, the preponderance of evidence standard has been met, therefore the allegations are found Substantiated. California Code of Regulations Title 22, Division 6, Chapter 1 are being cited on the attached LIC 9099D.

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

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250219122130
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: 02/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2025
Section Cited
CCR
80072(a)(1)
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80072(a)(1) - Personal Rights
(a) Except for children’s residential facilities, 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. This requirement was not met as evidenced by
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Administrator will provide personal rights training to all staff, including contracted staff and send proof to LPA by POC date which is 2/28/2025
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S5 was involved in loud argument with C1 antagonizing client during this incident by yelling at C1 and threatening to call the police on C1 which posses/posed a health and safety risk to persons in care.
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Type A
02/28/2025
Section Cited
CCR
80072(a)(3)
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80072(a)(3) - Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidenced by
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Administrator will provide personal rights training to all staff, including contracted staff and send proof to LPA by POC date which is 2/28/2025
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S5 threw a slipper at C1 during heated argument which posses/posed a health and safety 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: 02/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3