198601716-1-8-2024-28-AS-TVAO-CZCL3F-20240110072349

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601716
Report Date: 01/08/2024
Date Signed: 01/08/2024 12:46:35 PM

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
02/17/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220217100604

FACILITY NAME:	CHOICES R US - MIGUEL		FACILITY NUMBER:	198601716
ADMINISTRATOR:	CARDENAS, GILBERT		FACILITY TYPE:	735
ADDRESS:	3951 MIGUEL AVE		TELEPHONE:	(562) 801-3061
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	4	CENSUS: 4	DATE:	01/08/2024
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Marileen Carrillo		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Personal Rights/Questionable Death.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegation. LPA met with Marileen Carrillo and discussed the purpose of today's visit.

LPA Irra conducted the initial visit on 02/17/2022. During this visit, LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. During this visit, LPA reviewed Client #1 (C-1) file and obtained relevant documentation. Additionally, LPA obtained a copy of the staff roster with contact telephone numbers and a client roster.

During this investigation, LPA also interviewed Client #2 (C-2) through Client #5 (C-5), Staff #1 (S-1), Staff #2 (S-2) and Staff #4 (S-4). Staff #3 (S-3) is no longer working at this facility. LPA also called C-1 previous Service Coordinator from the placement agency and left a message for a return call.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

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-20220217100604

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: CHOICES R US - MIGUEL	FACILITY NUMBER: 198601716
	VISIT DATE: 01/08/2024

NARRATIVE

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Allegation: Personal Rights/Questionable Death. It is alleged that on 02/16/22, C-1 collapsed a few minutes into C-1’s walk and was foaming from C-1s mouth and part of C-1’s face had dropped. (3) out of the (4) interviewed clients indicated that C-1 wanted to go out for a walk and was not forced. Per client interviews, C-1 and C-3 were the only clients that participated in the community walk. (3) out of (4) interviewed clients indicated that C-1 appeared to be fine on 02/16/22. Per C-3, C-3 does not recall witnessing C-1 foaming from C-1’s mouth nor C-1’s facing dropping. Per interviews and reviewed documentation, during the walk, C-1 became tired and wanted to take a break. C-1 then proceeded to sit on the curb and after a couple of minutes, C-1 indicated C-1 was ready to continue with the walk. During this, C-1 was asked if C-1 wanted to return back to the home and C-1 wanted to continue walking. As the walk continued, C-1 then indicated C-1 wanted to take a nap and proceeded to sit and wanted to lay on a driveway. C-1 was not responding to staff redirection and was noticed not to be answering verbal prompts and “was drooling”. Staff then proceeded to call 911 and staff performed CPR until paramedics arrived. Shortly after the arrival of paramedics and Pico Rivera Sherrif’s Department, CPR was continued and was unsuccessful. C-1 was pronounced dead on scene. Per C-1’s death report, C-1 cause of death was due to “natural” causes.

Based on record review and interviews conducted the findings indicate, although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview conducted, appeal rights and a copy of this report was provided to Marileen Carrillo

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2024

LIC9099 (FAS) - (06/04)

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