198600673-2-2-2023-28-AS-RORN-CNW376-20230209165926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600673
Report Date: 02/02/2023
Date Signed: 02/02/2023 03:29:13 PM

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
01/25/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230125132157

FACILITY NAME:	HARVEST RESIDENTIAL CARE HOME		FACILITY NUMBER:	198600673
ADMINISTRATOR:	FABIAN, SHIELA ANA		FACILITY TYPE:	735
ADDRESS:	16302 HARVEST AVENUE		TELEPHONE:	(323) 469-3432
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	4	CENSUS: 4	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Sheila Fabian, Administrator		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Facility staff threw an object at resident while in care.
Facility staff inappropriately handled resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit in reference to the above allegations. LPA met with staff Samuel Bachillar. Administrator Sheila Fabian arrived shortly after.

The investigation consisted of the following: A tour of the interior and exterior physical plant was conducted. Plumbing project was observed. Staff (S1 & S2) and clients (C1-C4) were interviewed. Regional Center Service Coordinator was interviewed telephonically. Client (C1's) file documents, LIC 500 Personnel Report, and client roster were reviewed and obtained.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
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)

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Control Number 28-AS-20230125132157

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: HARVEST RESIDENTIAL CARE HOME	FACILITY NUMBER: 198600673
	VISIT DATE: 02/02/2023

NARRATIVE

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Allegation: Facility staff threw an object at resident while in care. It is alleged that staff (S1) threw a shoe at client (C1) that hit the client's head, and also almost hit the client's head with a chair. Based on interviews conducted the findings indicate that on January 25, 2023, client (C1) woke up early at 5 AM and wanted to go leave the facility so that they could go to the day program. The client started walking on the sidewalk alone and staff (S1) let the client go on it's own to the bus stop because staff could not leave the other clients unattended. NOTE: C1 is able to be in the community on it's own. Staff (S1) denied the allegation and stated that the client was angry. According Administrator, C1 has history of physical aggression and story fabrication and in the past year the client's behaviors have become more frequent. The Regional Center Service Coordinator confirmed that client (C1's) evaluations include story fabrication and it is difficult to redirect the client when they are angry and the incident has escalated. No injuries were observed in the client's head or body. Therefore, there is insufficient evidence to corroborate the allegation.

Allegation: Facility staff inappropriately handled resident while in care. It is alleged that staff (S1) did not handle the client's behavior incident appropriately by allegedly threatening to throw a chair at client (C1). According to two (2) staff and three (3) out of four (4) client interviews staff (S1) did not treat the client inappropriately of physically abuse the client on January 25, 2023. Client (C1) stated that S1 gets angry at clients when the Administrator is not present, and did attempt to hit the client with the high chair located in the kitchen counter. However, none of the other clients in the home witnessed the alleged shoe or chair throwing. Based on client (C1's) file documents the findings indicate that the client has six (6) problem behaviors; which include physical aggression, non-compliance, bossing others, behavioral outbursts, self-injurious behaviors, and story fabrication.

Based on record review and interviews conducted there is insufficient evidence to prove the 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 was conducted with Administrator Sheila Fabian. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
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)

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