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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601789
Report Date: 10/05/2023
Date Signed: 10/05/2023 01:11:37 PM

Substantiated


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
09/29/2023 and conducted by Evaluator Valeria Maldonado
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230929114228
FACILITY NAME:LC VOCATIONAL TRAINING CENTERFACILITY NUMBER:
198601789
ADMINISTRATOR:THERESA ZAROURFACILITY TYPE:
775
ADDRESS:1420 CLAREMONT BLVD., STE 205CTELEPHONE:
(909) 626-2900
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:30CENSUS: 22DATE:
10/05/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Janin Balmaceda- Assistant DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek client timely medical attention after sustaining a head injury at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) V. Maldonado made an unannounced initial complaint visit to the facility, for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Assistant Director, Janin Balmaceda, and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and the following documents for Client# 1 (C1): Fachesheet, Physician's Report, and current Individual Program Plan (IPP), and Incident Reports for the month of September 2023. Interviews were conducted with Staff# 1-3 (S1-S3) and Clients# 2-3 (C2-C3). A telephone interview was conducted with Client# 1 (C1) in private, due to C1 not at program today. Telephonic interview was also conducted with C1's Care Provider (CP). A copy of the Medical Visit Information was provided by CP to LPA for review.

(Report Continued on LIC9099-C...)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
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 5
Control Number 28-AS-20230929114228
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: LC VOCATIONAL TRAINING CENTER
FACILITY NUMBER: 198601789
VISIT DATE: 10/05/2023
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
The investigation revealed the following:

Regarding allegation: Staff did not seek client timely medical attention after sustaining a head injury at the facility.
It is alleged that on 09/29/23, staff failed to seek timely medical attention for C1 after C1 fell at C1's day program and hit C1's head against the refrigerator. Per interview conducted with C1, C1 confirmed to have fallen at day program and hitting C1’s head during the fall. Per C1, staff asked C1 if C1 was okay after the fall and helped C1 up. C1 was then told to stay seated for the remainder of the day and stayed at the day program until the end of the day. LPA asked C1 if medical attention or first aid was rendered, to which C1 stated nothing was offered or provided. Upon arriving home from day program, C1 notified CP of the incident occurred and CP took C1 to the hospital for further evaluation. Per interview conducted with CP, C1 called CP upon arriving home from day program and notified CP of the incident. CP stated to have been concerned after C1 told CP to have felt "tired" after learning C1 had a fall with a head injury at the day program. CP stated that the hospital attending physician diagnosed C1 with traumatic hemorrhaging of the brain due to the fall C1 had. Per the Medical Visit Information review, it was discovered that the attending physician noted C1 diagnosed with Traumatic Brain Hemorrhage. Per interviews with S1-S3, (3) of (3) staff admitted to C1 falling and hitting C1’s head. S1 and S2 stated that following the fall, C1 was checked for visible injuries by S1 and S2 and was observed for any changes in condition that would indicate C1’s injuries were severe. C1 was not sent home early and per S1, an ice pack was given to C1. (2) of (3) staff were unaware if medical attention or first aid was rendered or offered by other staff to C1. (3) of (3) staff could not answer what the policy or protocol is following a head injury of a client, other than observation for visible injury and/or symptoms of severe injuries. After review of C1’s Physician’s Report and current IPP, it was noted that C1 is ambulatory, does not have any history of falls, and is not deemed a fall risk. It was noted that the day program filed an incident report timely to the licensing department, and C1’s placement agency, as well as calling the licensing department to report the incident, on 09/29/23. Per the incident reports obtained, the incident occurred on 09/28/23. (2) of (3) clients interviewed could not corroborate the allegation.

Based on LPA's observations, records review, and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is Substantiated.



Per California Code of Regulations, Title 22, deficiencies will be cited on the LIC9099-D.

Exit interview was conducted and a copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20230929114228
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: LC VOCATIONAL TRAINING CENTER
FACILITY NUMBER: 198601789
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
80075(a)
1
2
3
4
5
6
7
80075 Health Related Services
(a) The licensee shall ensure that each client receives necessary first aid and other needed medical...services...

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee to conduct in-service training with all staff on when first aid and medical attention should be provided/offered. A copy of the training material and attendance sheet will be emailed to LPA by the POC due date.
8
9
10
11
12
13
14
Based on observation, interviews, and records review, the licensee failed to seek timely medical attention for a client following a fall with a head injury, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
09/29/2023 and conducted by Evaluator Valeria Maldonado
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230929114228

FACILITY NAME:LC VOCATIONAL TRAINING CENTERFACILITY NUMBER:
198601789
ADMINISTRATOR:THERESA ZAROURFACILITY TYPE:
775
ADDRESS:1420 CLAREMONT BLVD., STE 205CTELEPHONE:
(909) 626-2900
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:30CENSUS: 22DATE:
10/05/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Janin Balmaceda- Assistant DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client sustained an unwitnessed fall at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) V. Maldonado made an unannounced initial complaint visit to the facility, for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Assistant Director, Janin Balmaceda, and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the client and staff roster, and the following documents for Client# 1 (C1): Fachesheet, Physician's Report, and current Individual Program Plan (IPP), and Incident Reports for the month of September 2023. Interviews were conducted with Staff# 1-3 (S1-S3) and Clients# 2-3 (C2-C3). A telephone interview was conducted with Client# 1 (C1) in private, due to C1 not at program today. Telephonic interview was also conducted with C1's Care Provider (CP). A copy of the Medical Visit Information was provided by CP to LPA for review.

(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: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20230929114228
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: LC VOCATIONAL TRAINING CENTER
FACILITY NUMBER: 198601789
VISIT DATE: 10/05/2023
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
The investigation revealed the following:

Regarding allegation: Client sustained an unwitnessed fall at the facility.
It is alleged that C1 had an unwitnessed fall at the facility on 9/29/23, that resulted in a head injury. Per interview with C1, it was stated that C1 did in-fact have a fall at C1’s day program. However, the fall was witnessed by S2 and S3, who helped C1 get up after the fall. C1 stated to have been walking toward the refrigerator and fell near the refrigerator due to wearing the wrong shoes. Per interviews conducted with staff, (2) of (3) staff witnessed the incident and (1) staff was made aware of the incident immediately after it occurred. S2 stated to have been talking with C1 in the lunchroom when the incident occurred. S2 stated C1 was walking away still talking to S2 when S3 walked into the room and C1 appeared to have gotten startled by S3 and fell back. S2 described C1 falling on to the floor on their buttocks first, following C1’s head going back and hitting C1’s head on the wall. Nobody else witnessed the incident. S2 and S3 asked C1 if C1 was okay, to which C1 answered yes, and C1 was helped up by S2 and S3. (2) of (3) clients interviewed could not corroborate the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged. Therefore, the complaint investigation of the allegation is Unsubstantiated.

No Deficiencies were observed or cited under California Code of Regulations Title 22.

Exit interview was held and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5