198601569-5-9-2025-28-AS-RORN-DHHSU6-20250610141033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601569
Report Date: 05/09/2025
Date Signed: 05/09/2025 01:15:47 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
05/02/2025 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250502100004

FACILITY NAME:	CARRUTHERS HOME		FACILITY NUMBER:	198601569
ADMINISTRATOR:	BRENDA WATKINS		FACILITY TYPE:	735
ADDRESS:	2498 LEEBE AVE		TELEPHONE:	(909) 274-7554
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	4	CENSUS: 4	DATE:	05/09/2025
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Brenda Hawkins		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley conducted a 10 day complaint visit at the facility and met with Brenda Hawkins and Jimmy Watkins to discuss the purpose for todays visit.

Investigation consisted of: staff roster, resident roster, reviewed residents, reviewed residents missed medications, reviewed medication log, reviewed residents#1 file, called Pomona police department, SGPRC staff, interviewed staff #1, staff #2, attempted to interview resident #1 and retrieved specific items from residents #1 file.

Investigation revealed: Staff spoke inappropriately to resident. LPA Wesley attempted to interview resident #1 and he began saying since your from licensing am I supposed to be scared of you? I answered No, I am just here to ask questions about the incident involving you and the staff. He went on using obscenities, toward me and the Administrator and he was saying things like I dont have to go to the doctor or take my medication

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

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-20250502100004

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: CARRUTHERS HOME	FACILITY NUMBER: 198601569
	VISIT DATE: 05/09/2025

NARRATIVE

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all they are going to do is take my fingerprints. He went on asking for cigarettes and calling the service coordinator the "N" word and has a history of fabricating and the resident did jump out of the car while they were at labs and it was moving, but she didn't curse at him she just yelled the persons name, and another time he jumped out the care. Another time he jumped out of the car while the administrator was coming into a driveway, she just called the residents name and told him not to do that, and wouldn't let him back into the car and had a staff ride the bus back with the resident.

The administrator said resident #1 is out of control and their behaviors are not normal. They began slamming the glass sliding door, slamming the front door, threw their cellphone, and broke the fence. The Administrator called the Pomona Police, and paramedics and they took the residents blood sugar, the reading was 442, so the ambulance took the resident to the Pomona Valley hospital. The Pomona Valley Police Officers name was Garcia, and the report number is #25-038556.

Based on interviews conducted, and information that was gathered, there is insufficient evidence to support the allegation. 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.

A copy of this report was given to the Administrator during the exit interview.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2025

LIC9099 (FAS) - (06/04)

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