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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601228
Report Date: 12/20/2021
Date Signed: 12/24/2021 11:26:23 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
10/22/2020 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201022112232
FACILITY NAME:VERMONT CARE CENTERFACILITY NUMBER:
198601228
ADMINISTRATOR:PHIDIAS BARRIOSFACILITY TYPE:
735
ADDRESS:1316 S. VERMONT AVE.TELEPHONE:
(213) 384-1682
CITY:LOS ANGELESSTATE: CAZIP CODE:
90006
CAPACITY:76CENSUS: 55DATE:
12/20/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Phidias Barrios, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff unnecessarily sent client to hospital.
Facility staff did not notify client’s authorized representative of unusual incidents.
Facility staff speak inappropriately to client.
Facility is not clean.
Facility has bed bugs.
INVESTIGATION FINDINGS:
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This report is an amendment and will supersede the initial report issued on 6/4/2021 to clarify the details of the findings. The findings did not change and remain as Unsubstantiated.

On 6/4/2021. Licensing Program Analysts (LPAs) Cynthia Chan, Nune Margaryan, and Nina Galarza conducted a subsequent complaint investigation for the allegations listed above. LPAs met with Jeanine Machado and explained the purpose of the visit. Administrator, Phidias Barrios, arrived at 11am.

The investigation consisted of the following:
On 10/29/2020, LPA Chan conducted the initial visit which consisted of telephone interviews with the House Manager and 7 Clients. A video call was also done to observed rooms #5, #6, #7, #8, #16, #17, and #27. LPA requested copies of the Client rosters, LIC500 Personnel Report, documentation of Personal Right training for staff, and Termite/Pest Control report from August through October 2020.
(Continue on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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-20201022112232
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: VERMONT CARE CENTER
FACILITY NUMBER: 198601228
VISIT DATE: 12/20/2021
NARRATIVE
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In addition, LPA requested copies of the following for Client #1 (C1): Eviction notice, Physician's Report, Appraisal/Needs and Services Plan, Hospital discharge paper, and Police report. During today’s visit, LPAs toured the facility and interviewed additional 2 Staff and 3 Clients.

The investigation revealed the following:

Allegation – Facility staff unnecessarily sent client to hospital. It was alleged that Client #1 (C1) was sent to the hospital under false pretense of alcohol and polysubstance abuse. Based on interview with the Assistant Administrator, C1 was sent to the hospital due to yelling, screaming, and wanting to hit the Administrator. C1’s mother was contacted and agreed for staff to send C1 to the hospital. Per the Administrator, a client is sent to the hospital because immediate medical attention is needed and which he spoke with the C1’s doctor who recommended for the client to be sent to the hospital. He stated that C1 was displaying a danger to self and others at the facility due to the increase erratic behaviors that were presented more recently. At the hospital, C1 was tested for substance abuse which results were negative. However, hospital assessment showed that C1 was having suicidal ideation. There is insufficient evidence to show that C1 was sent to the hospital for unnecessary reasons.

Allegation - Facility staff did not notify client’s authorized representative of unusual incidents. The Assistant Administrator stated that she would normally contact C1’s responsible party when unusual incidents occur. However, if she is not available to do so, Administrator Barrios would make the call. Per Administrator Barrios, he stated he was often in contact with C1’s mother to notify of C1’s increased aggressive behaviors. As indicated on the eviction notice dated 10/5/20 and incident reports, C1 went after a staff with a knife and tried to hit the Administrator. Mr. Barrios stated he informed C1’s mother of the incident and was one of the reasons for the eviction notice served. Based on information obtained, there is insufficient evidence to corroborate this allegation.

Allegation - Facility staff speak inappropriately to client. According to interviews with staff, they denied speaking inappropriately to clients. Staff have training on client’s rights and stated that they do not make fun, use vulgar words, or talk badly about the clients. They have not heard any other staff speaking inappropriately to clients either. 8 out of the 10 clients interviewed stated that staff have not spoken to them inappropriately. Some said that the staff are respectful, nice, and helpful.

(Continue on next page)

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20201022112232
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: VERMONT CARE CENTER
FACILITY NUMBER: 198601228
VISIT DATE: 12/20/2021
NARRATIVE
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Allegation - Facility is not clean. On 10/29/20, LPA Chan conducted a virtual tour of 7 random rooms and all appeared orderly. During the visit on 6/4/21, LPAs toured the facility and saw housekeepers cleaning. Clients interviewed stated that the facility is clean and their rooms are cleaned once to twice a week. The floors get mopped, drapes get cleaned, and trash are taken out. Housekeeping Staff were interviewed and stated that they clean daily and are responsible for their own floors.

Allegation – Facility has bed bugs. All the staff interviewed denied having bed bugs at the facility. 8 out of 10 clients interviewed stated they have not seen any bed bugs or any lately. 2 stated they have observed bed bugs in their beds; one seen some last month while another seen some last week. LPA obtained and reviewed the pest control from Aug 2020 – October 2020 and report did not show any findings of bed bugs at the facility. Staff interviewed stated they have not observed any bed bugs.

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.



An exit interview was conducted. A copy of this report and appeal rights were given to the Administrator.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3