198602019-9-21-2022-28-AS-RORN-CK4MA8-20221011092554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602019
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:55:22 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
09/16/2022 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20220916122855

FACILITY NAME:	PEOPLE'S CARE COVINA HILLS		FACILITY NUMBER:	198602019
ADMINISTRATOR:	RAMOS, JOLLIEREY (JOLLIE)		FACILITY TYPE:	735
ADDRESS:	1412 E COVINA HILLS RD		TELEPHONE:	(626) 498-0075
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	4	CENSUS: 3	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Irene Sandoval, Staff Jollie Ramos, administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff handled resident roughly.
Resident was injured by staff while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Tao and Ramirez conducted an unannounced complaint visit to the facility. Upon arrival, LPAs met with Irene Sandoval, staff, and Jollie Ramos, Administrator. LPAs explained the purpose of the visit to both of them.

During today's visit, LPA obtained a copy of the Staff/Client roster, client#1’s file and client#1’s regional center report, dated 09/16/22.

The investigation consisted of client interviews, staff interviews, client#1 file review and LPAs observation.
In regards to the allegation, “staff handled resident roughly”, it was alleged that staff pushed the client into a wall in client's room and choked client. The investigation revealed that LPAs interviewed clients, three (3) out of four (4) clients was not corroborated with the allegation.

(- continue to LIC9099C -)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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-20220916122855

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: PEOPLE'S CARE COVINA HILLS	FACILITY NUMBER: 198602019
	VISIT DATE: 09/21/2022

NARRATIVE

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Client#1 (C1) was not at the facility and LPAs were unable to contact C1 during the visit. Interviews of staff revealed three (3) out of three (3) staff denied the allegation. LPAs observed other clients at the facility and they seemed happy staying at the facility. Review client#1’s file indicated C1 had tendency of fabricating false statements. Therefore, the allegation of staff handled clients roughly was not valid.

In regards to the allegation, “resident was injured by staff while in care”, it was alleged that client had bruised after staff pushed the client into a wall in client's room and choked client. The investigation revealed that LPAs interviewed clients, three (3) out of four (4) clients was not corroborated with the allegation. Interviews of staff revealed three (3) out of three (3) staff denied the allegation. As mentioned above, Client#1 (C1) was not at the facility. In addition, review of C1’s regional center report, dated 09/16/22, revealed that incident dated 09/16/22, was determined to be inconclusive. Therefore, the allegation of client was injured by staff while in care was not valid.

Although the allegations 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.

No deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted with Administrator, Jollie Ramos. A hard copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

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