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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600717
Report Date: 08/23/2024
Date Signed: 08/23/2024 02:30:43 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
08/16/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240816110720
FACILITY NAME:FRANCISQUITO HOMESFACILITY NUMBER:
198600717
ADMINISTRATOR:TUASON, CYNTHIAFACILITY TYPE:
735
ADDRESS:15704 EAST FRANCISQUITO AVENUETELEPHONE:
(626) 918-6712
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:6CENSUS: 6DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator Cynthia Tuason TIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Resident sustained injuries due to staff neglect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation above. LPA met with staff Ada Hernandez and the purpose of the visit was discussed. Administrator Cynthia Tuason arrived shortly after.

On todays visit, LPA Villalobos toured the physical plant, interviewed Staff #1-#3 (S1-S3), Clients #1-#6 (C1-C6), collected copies of the staff and client rosters. The following documents were observed and collected from C1's file: Facesheet, physicians report, daily notes from the month of august 2024, Individual Program Plan (IPP), semi-annual behavioral consultant progess report, and body check forms for august. The investigation revealed the following:

In regards to the allegation "Resident sustained injuries due to staff neglect" it was alleged that staff bruised C1s bicep and scratched C1's shoulder and chin in the facility....

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
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 2
Control Number 28-AS-20240816110720
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: FRANCISQUITO HOMES
FACILITY NUMBER: 198600717
VISIT DATE: 08/23/2024
NARRATIVE
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 (3) of (3) Staff interviewed denied the allegation. (6) of (6) Clients interviewed could not corroborate the allegations. Details initially provided were that staff allegedly bruised C1's bicep when taking their papers and bracelet from them on 8/15/24 and scratched C1's shoulder and chin when cutting C1's nails. Staff interviewed stated that they have never grabbed C1 inappropriately or scratched C1 during the time they cut C1's nails. Interviews added that C1 has a behavior of collecting trash and soiled paper then hiding it under their bed. C1 will attempt to take soiled papers with them to their day program in the morning but staff will clean out the mess and verbally redirect client to hand over any trash so it can be disposed properly. No items are pulled away from the client and staff do not put their hands on client. Review of C1's IPP and progress reports shows this behavior to be true. Note from staff dated 8/15/24 shows that in the morning staff explaining to resident to not take their items to day program because they were soiled with urine. Interviews with staff further explain that C1 bumps into their bed frame when C1 hides and collects things from under the bed and that is were C1 may have gotten any discoloration or scratches. Staff explained that they have never had an issue with C1 while cutting their nails. File review shows that C1 has self injurious behaviors that result in scratches and bruises as well as details of what C1's hides under their bed. C1's interview was not able to corroborate the allegations as C1 stated the incidents alleged did not occur. Based on interviews, file review, and observations; although the allegations may have happened or is 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 conducted and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2