198600473-9-24-2021-28-AS-SCOL-CCYLK2-20220329084849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600473
Report Date: 09/24/2021
Date Signed: 09/24/2021 10:50:24 AM

Unsubstantiated

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
09/17/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210917112139

FACILITY NAME:	GEMLY'S HOME CARE		FACILITY NUMBER:	198600473
ADMINISTRATOR:	RODRIGUEZ, GEMMA A.		FACILITY TYPE:	735
ADDRESS:	1309 LA SERENA DRIVE		TELEPHONE:	(909) 967-6966
CITY:	GLENDORA	STATE: CA	ZIP CODE:	91740
CAPACITY:	6	CENSUS: 6	DATE:	09/24/2021
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Ulysses Rodriguez; Administrator		TIME COMPLETED:	11:06 AM

ALLEGATION(S):

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Facility is mismanaging client's funds.
Staff yells at client in care.
Staff speaks inappropriately to client in care.
Staff threaten client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above allegations. LPA met with DSP Violeta Tailan and explained the reason for the visit. Administrator Uysses Rodriguez arrived shortly thereafter.

The investigation consisted of the following: LPA obtained copies of client and staff rosters. LPA also reviewed Client #1's file and obtained copies of FACE Sheet, Most Recent IPP, and September P&I Ledger. LPA also interviewed Client #1 - Client #5, Administrator, and Staff #1 - Staff #2. Client #6 was not interviewed as C6 is non-verbal.

The investigation revealed the following: in regards to the allegation "facility is mismanaging client's funds", it is alleged that C1's funds are being stolen. No specific details were provided. Staff members interviewed denied this allegation. C1 and other clients interviewed also denied this allegation. Clients interviewed indicated that they receive their funds when they request it from staff. (CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

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-20210917112139

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: GEMLY'S HOME CARE	FACILITY NUMBER: 198600473
	VISIT DATE: 09/24/2021

NARRATIVE

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During today's visit, LPA reviewed C1's P&I ledger and observed it to be accurate and updated. Facility also keeps receipts of client transactions and purchases. C1 has signed out every time she has received funds. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegation "staff yells at client in care", it is alleged that S1 was being verbally abusive towards C1 on 09/10/21. Interviews conducted with C1 indicated that S1 does not yell at her. Interviews conducted with the other clients also denied this allegation and indicated that staff members do not yell at them. Interviews conducted with staff members also denied this allegation. Staff members interviewed indicated that they treat all clients with respect and dignity. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to the allegations "staff speaks inappropriately to client in care" and "staff threaten client in care", it is alleged that S1 was heard being rude yelling things to C1 such as "I am not going to shower you", "I don't like you" and "do you want to go back to the Skilled Nursing Facility?". Interview conducted with C1 denied these allegations. C1 indicated that S1 did not say those things to her. Interviews conducted with the other clients all denied these allegations and indicated that they did not hear S1 saying those statements. Interview conducted with S1 denied these allegations. Interview conducted with other staff members indicated that they treat all of the clients with respect and do not yell or threaten the clients. Therefore there was insufficient evidence to corroborate with this allegation.

Additionally, The San Gabriel/ Pomona Regional Center also conducted an investigation into these allegations and their findings were Unsubstantiated.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Rebecca Orendain
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021

LIC9099 (FAS) - (06/04)

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