198601304-9-5-2023-28-AS-RORN-CVNN7D-20230914101234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601304
Report Date: 09/05/2023
Date Signed: 09/05/2023 12:34:27 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
03/12/2021 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210312144952

FACILITY NAME:	BAILEY CARE HOME #4		FACILITY NUMBER:	198601304
ADMINISTRATOR:	SHAWN L. BAILEY		FACILITY TYPE:	735
ADDRESS:	10413 VULTEE AVE.		TELEPHONE:	(562) 622-0806
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	4	CENSUS: 4	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jamila Neal- Direct Support Professional (DSP)		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff did not safeguard a client's personal belongings.
Staff speaks inappropriately towards the client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced, subsequent visit at the facility for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Direct Support Professional (DSP) Jamila Neal and explained the purpose for the visit.

On 3/19/21, LPA Kruz Long made an initial complaint visit to investigate the allegations. Investigation consisted of the following: LPA interviewed Staff #1 (S1) and Client #1 (C1) and requested a copy of the Staff/Client Roster. On 7/01/21, LPA Long conducted a telephonic interview with Client #2 (C2).

During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and obtained the following documents for Client's #1-3 (C1-C3): Facesheet, Physician's Report, and Individual Program Plan (IPP). Interviews were also conducted with Staff #2-4 (S2-S4), and an interview with Client# 3 (C3) was attempted.

(Report Continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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-20210312144952

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: BAILEY CARE HOME #4	FACILITY NUMBER: 198601304
	VISIT DATE: 09/05/2023

NARRATIVE

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The investigation revealed the following:
Regarding allegation: Staff did not safeguard a client's personal belongings.
It is alleged that on the morning of 3/01/21, C1 noticed some personal items were missing and suspected S1 of stealing them while C1 was sleeping. Per interviews conducted, (2) of (3) clients stated that personal items went missing at the facility and were not found. (4) of (4) staff stated C1 and C2 expressed missing items at times, however both clients have a history of fabricating stories. Per review of IPP's, it was discovered that C2 does have a history of behaviors of falsifying stories. Per S2, S2 does recall an incident of C1 notifying staff of personal items missing some time in March of 2021, but is unaware of C1 stating the items were "stolen". S2 states to have spoken to C1's mother to check if C1 had left the alleged stolen items at C1's family's home, as C1 would frequently visit their family and would take personal belongings with them. S2 states C1's mother did not find C1's items at the family home, so S2 replaced the alleged stolen item for C1. This allegation is Unsubstantiated.
Regarding allegation: Staff speaks inappropriately towards the client while in care.
It is alleged that S1 speaks disrespectfully to some of the clients in the home. Per interviews conducted, C1 stated that S1 was experiencing personal issues outside of work, would come to work with an attitude, and would take it out on the clients. C1 did not provide details on how S1 was allegedly "taking it out" on clients or how it was known that S1 was having personal issues. C2 stated that S1 beat C2 on the nose, tried to choke C2, and hit C2 in the jaw. C2 stated that S2 was aware and consequently fired S1. (4) of (4) staff stated to be unaware of an incident where a staff physically abused a client in care or spoke inappropriately to them. Per C2's IPP, it is noted that C2 has a history of fabricating stories. S2 states to be unaware of an incident where S1 physically abused C2, nor did S2 take any pictures of a client with suspicion of abuse. S2 states if S2 had knowledge of said incident, it would have been reported. S2 also states that S1 was not fired, but rather left on their own terms. This allegation is Unsubstantiated.

Based on record review and interviews conducted the findings indicate, 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.

Per California Code of Regulations, Title 22, no deficiencies were observed or cited during today's visit.

An exit interview was conducted with DSP, Jamila Neal, and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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