198601386-3-24-2021-28-AS-MVAO-C5SQ9W-20210811115901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601386
Report Date: 03/23/2021
Date Signed: 03/24/2021 07:37:01 AM

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
03/15/2021 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210315143752

FACILITY NAME:	RUBY GEM HOME CARE		FACILITY NUMBER:	198601386
ADMINISTRATOR:	SAMONTE, MICHELLE TORRES		FACILITY TYPE:	735
ADDRESS:	836 HALLWOOD AVE		TELEPHONE:	(909) 447-4649
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	6	CENSUS: 4	DATE:	03/23/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jesenia Flores (Lead Staff) and Michelle Samonte (Facility Administrator)		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff did not allow client to make a phone call.
Facility staff handled client in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Jesenia Flores (Lead Staff). LPA also discussed this complaint with Michelle Samonte (Facility Administrator).

At approximately 9:30AM, LPA inteviewed Staff #1 through Staff #3 (S-1 through S-3) and Client #1 through Client #4 (C-4). LPA also interviewed the Facility Administrator

LPA equested Lead Staff and Facility Administrator for documentation revelant to the above allegations.

Refer to LIC 9099 for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

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-20210315143752

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: RUBY GEM HOME CARE	FACILITY NUMBER: 198601386
	VISIT DATE: 03/23/2021

NARRATIVE

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Allegation: Facility staff did not allow client to make a phone call. Staff interviews revealed that staff do not prohibit any clients from using the telephone. Staff interviews revealed (3) out of the (4) clients own their own cell phone and at times they use the facility phone. Staff interviews also revealed that C-2 and C-3 call their family member (s) on a daily basis. Staff interviewed indicated they also assist Clients in dialing the phone numbers for them. Interviewed Staff indicated they have not received any reports nor have observed any staff not allowing clients the use of the telephone. Interviewed staff also indicated they are trained in Mandating Reporting, Client Rights and CPI . (1) out of (4) interviewed clients indicated staff do not allow clients to use the phone. However, the (1) client alleging this was unable to provide further details such as dates and time frames. (3) out of (4) clients indicated staff allow clients to use the telephone when requested. Staff and client interviews do not corroborate this allegation.

Allegation: Facility staff handled client in a rough manner. Staff interviews revealed that staff do not handle clients in a rough manner (including grabbing arms, twisting them and hitting clients’ heads). Interviewed Staff indicated they have not received any reports nor have observed any staff handling clients in a rough manner. Interviewed staff also indicated they are trained in Mandating Reporting, Client Rights and CPI. (1) out of (4) interviewed clients indicated staff handle clients in a rough manner. However, the (1) client alleging this was unable to provide further details such as dates and time frames. (3) out of (4) clients interviewed indicated that staff do not handle clients in a rough manner. Interviewed clients have not witnessed staff handling clients in a rough manner. Staff and client interviews do not corroborate this allegation.

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.

A telephonic exit interview was conducted with the Facility Administrator, a hard copy was provided via email for signature and Appeal Rights were also provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021

LIC9099 (FAS) - (06/04)

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