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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600947
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:55:05 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
01/27/2023 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20230127112115
FACILITY NAME:JAMERIKA HOME CARE, INC.FACILITY NUMBER:
198600947
ADMINISTRATOR:FERRER, AMALIA A.FACILITY TYPE:
735
ADDRESS:5025 BURNABY DRIVETELEPHONE:
(626) 732-2912
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:6CENSUS: 6DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amalia Ferrer, administratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff spoke inappropriately to client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met Administrator, Amalia Ferrer. LPA explained the purpose of today's visit regarding the above-mentioned allegation.

Investigation consisted of the following: interviews of staff from staff #1 (S1) through staff #3 (S3); attempted to interview of Client#1 (R1); reviews of client#1’s record, and a facility tour. LPA obtained copies of staff and client Rosters; and client files of client#1 (C1) and relevant information.

In regard to allegation, “staff spoke inappropriately to client in care," it was alleged that staff used inappropriate language speaking to client#1. The investigation revealed the following: administrator stated the incident happened at client's day program. LPA conducted phone interview with day program director, Staff#3 (S3), who confirmed the incident happened at the day program and staff involved in this allegation were day program's staff.
(-continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
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)
Page: 1 of 2
Control Number 28-AS-20230127112115
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: JAMERIKA HOME CARE, INC.
FACILITY NUMBER: 198600947
VISIT DATE: 02/02/2023
NARRATIVE
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Day program director state that a complaint investigation was taking place at the day program regarding this allegation. LPA attempted to interview client#1 (C1). Client was non-comprehensive to answer question.

File review revealed that Staff#3, day program director had filed an incident report, dated 1-26-23, to Licensing to report the incident occurred at the facility regarding the allegation. Therefore, staff did not spoke inappropriately to client in care at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegations is UNSUBSTANTIATED.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with administrator. A hard copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
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)
Page: 2 of 2