<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601674
Report Date: 08/09/2024
Date Signed: 08/09/2024 11:48:07 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/15/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240715140310
FACILITY NAME:FAIRGREEN HOUSEFACILITY NUMBER:
198601674
ADMINISTRATOR:GEORGE LOPEZFACILITY TYPE:
735
ADDRESS:2051 FAIRGREEN AVETELEPHONE:
(626) 443-1313
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:4CENSUS: 4DATE:
08/09/2024
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH: Ricardo Montes - AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is physically and verbally abusing clients in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to continue investigating the above allegation. Upon arrival, LPA rang the doorbell several times but no one answered the door. LPA called the Administrator but no response. LPA called the Hope House and they indicated that they will help facilitate contact with the Administrator. At 10:20am, Administrator, Genny Guadalquivir called LPA back, stated that she will send someone to assist LPA at the facility. At 10:45am, LPA was met by Administrator, Ricardo Montes who allowed LPA entry and discussed the purpose of the visit.

The investigation consisted of the following: On 07/23/2024, LPA Pena conducted a physical plant tour and obtained copies of the Staff/Client rosters, House Rules, Charting/Progress Notes (June 2024 - July 2024), Monrovia Police Report number (TEM0209), LA County APS contact information and Staff In-service training about Personal Rights, Clients Rights, Mandated Reporting and Zero Tolerance Policy. LPA also obtained Client #1 (C1) - Client #2 (C2) files such as Admission Agreement, Identification & Emergency Information, Physician's Report, Latest IPP and Medication Administration Records (MARs) for May 2024-July 2024. LPA interviewed Staff #1 (S1) - Staff #3 (S3) in person, and Staff #4 (S4) - Staff #5 (S5) telephonically and unsuccessfully interviewed Client #2 (C2) - Client #3 (C3) due to their cognitive abilities.
During today's visit, LPA toured the physical plant and attempted to interview Client #1 (C1) and Client #4 (C4) at the Day Program but unsuccessful due to their cognitive abilities. LPA telephonically interviewed Staff #6 (S6) - Staff #7 (S7) on 7/25/2024.***CONTINUED ON LIC9099-C***
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
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-20240715140310
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FAIRGREEN HOUSE
FACILITY NUMBER: 198601674
VISIT DATE: 08/09/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation: “Staff is physically and verbally abusing clients in care.” It is alleged that a staff was yanking C1's arms, shoving their heads downwards, using foul language, agitating them and told C1 to “get the fuck up” multiple times. It is also alleged that another staff sat on C2's legs and putting weight to restrict him from moving around. (5) out of (7) staff interviewed denied the allegation and stated that they are aware of the clients’ rights. Of the (2) staff who corroborated the allegation, only (1) staff witnessed the incident firsthand while the other staff was not present and was only told about the incident. Interview with S1 revealed that in the morning of 7/12/2024, a staff reported to her that C1 ran outside to the front and as S7 tried to stop him, C1 pushed S7, and both tripped up and fell to the ground. This resulted in C1's injury on his left wrist and pinky finger. Staff applied first aid to C1, but no hospitalization. In the afternoon on the same day, C2 was agitated and pushed C1 to the floor and as a result, C1 sustained a bruise on the left side of the hip. Staff immediately assisted by administering first aid and conducting a body check on C1. S1 indicated that APS, Monrovia Police Dept came to investigate the allegation on 7/15/2024 and did not note any concerns. The Regional Center (SGPRC) is aware of the incident and in the process of investigating. LPA attempted to interview C1-C4, but unsuccessful due to their cognitive abilities. Records reviewed revealed that the incident was documented on C1-C2’s progress notes and an incident report (SIR) was submitted to CCL on 7/16/2024. Based on all interviews conducted as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 allegation is UNSUBSTANTIATED.



Exit interview, a copy of this report was provided to Ricardo Montes, Administrator.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2