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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602019
Report Date: 10/14/2022
Date Signed: 10/14/2022 03:51:28 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
04/22/2021 and conducted by Evaluator Ashley Calderon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210422092344
FACILITY NAME:PEOPLE'S CARE COVINA HILLSFACILITY NUMBER:
198602019
ADMINISTRATOR:RAMOS, JOLLIEREY (JOLLIE)FACILITY TYPE:
735
ADDRESS:1412 E COVINA HILLS RDTELEPHONE:
(626) 498-0075
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:4CENSUS: 3DATE:
10/14/2022
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:TIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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On 10/14/22 Licensing Program Analyst (LPA) Ashley Calderon did a unannounced visit to the above facility for the allegation listed above. LPA Calderon met with House Lead Krystal Baker to deliver findings of the above allegation and discussed the purpose of todays visit. Complaint came in 2021 during Covid-19 , 4 clients census at the time.

Based on the information reviewed and the interviews conducted on 10/13/22 staff census 2, LPA Calderon determined that facility is operating out of ratio. Interviews conducted on 10/13/22 with staff from Staff # 3 and #4 (S3, S4) both mention that there is not sufficient staff meeting each clients needs and service plans. S3 and S4 mentioned C2 is considered to be a line of sight client. C4 states line of sight means "someone will be with C2 arm length of the their body , and have space but we (staff) can see them visually incase they disests anything that isn't edible. S4 mentioned that C2's behavior in becoming aggression can escalate quickly.
See 9099-C continuation plan ...
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
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 3
Control Number 28-AS-20210422092344
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: 10/14/2022
NARRATIVE
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 Client #1, #3 and #4 during the interview conducted by LPA Calderon on 10/13/22 all stated they need more staffing to help out and C1 and C3 mentioned they don't feel safe with C2 due to their behaviors and needs, and attention they receive by staff.

On 4/30/21 LPA Tao received Employee Punch Report for the above facility by Administrator Jollie Ramos. LPA Calderon reviewed Employee Punch Reporting hours for the month of March 2021 and based on review LPA noted 1 staff present to 4 clients. For the days and hours showing 1 staff present: March 3, 2021 10:30pm-6:30am, March 5 2pm-10pm, March 6 2pm-10pm, 9pm-6am , nocturnal shift no employees reported on punch report. March 11 10pm-6:20am, March 12 10pm-6am, March 14 2pm-10pm, March 18 10pm-6am, March 19 6am-2pm, March 20 6am-2:10pm, 2pm- 10pm, March 21 10pm-1:20am, from 1:20am-6am no staff marked in Employee Punch Report,March 23 10pm-6:10am, March 29 2pm-10pm, March 30 10pm-6:10am, and March 31 6am-2pm, 10-6:20am.

Based on the above home Program Design it states " People's Care Covina Hills will provide at least 396 hours of direct support per week when there is a census of 4 residents in the home. The staffing schedule will include a minimum, two awake and on duty staff 24 hours per day, 7 days a week. The use of secured perimeters shall not substitute for adequate staff in sufficient numbers to meet the care and supervision needs of all residents, including additional staffing as determined to be necessary by a resident's Regional planning team. On-call staff will be available Monday -Friday during work program hours, in the event that a resident does not attend day program. There will be no less than two direct support staff at all times when residents are under supervision of facility staff and approved staffing schedules will be followed. The facility failed to have adequate staffing, they shall of a minimum of 2 staff on duty at all times when residents are under supervision and facility should met the hours specified by Regional Center.

Based on LPAs Calderon findings, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 6 are being cited on the attached LIC 9099D.

An exit interview was held , reports were provided to House Lead Krystal Baker and appeal rights were given.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20210422092344
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited
CCR
85065(b)
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(b)The licensee shall employ staff as necessary to ensure provision of care and supervision to meet clients needs.

The requirement is not met as evidenced by:
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LPA Calderon spoke to Krystal Baker and Baker will ensure to inform administrator Jollie that he will review Program Desig, review Title 22 on Personnel Requirements and will place proper staffing due to clients needs and ratio. POC is show prrof of staffing documentation.
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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: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3