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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602019
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:40:26 PM

Substantiated


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
02/11/2025 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250211151603
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:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jorden Seymour - Direct Support Staff TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff use inappropriately language in the presence of clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Jorden Simour and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/client roster. LPA conducted interviews with 3 staff and 1 client in person. LPA interviewed Administrator, 1 client, and 2 staff over the phone. LPA interviewed client #2(C2) Day Program’s Regional Manager. LPA requested copies of clients #1-2(C1-C2) admissions agreement, face sheet, behavioral assessments, individual service plan, and daily notes from 2/13/25-2/20/25. LPA interviewed San Gabriel Pomona Regional Center’s Service Coordinator and requested copies of individual program plan over the phone.

Regarding allegation: Facility staff use inappropriately language in the presence of clients. It is alleged staff had an argument and used foul language in front of the clients.
(CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20250211151603
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: PEOPLE'S CARE COVINA HILLS
FACILITY NUMBER: 198602019
VISIT DATE: 02/20/2025
NARRATIVE
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. Interviews conducted with clients revealed 1 out of 2 clients interview stated staff were inappropriate in their presence. Interviews conducted with staff revealed clients have witness two incidents between staff, in which staff used inappropriate communication around the clients. Per staff, there was an incident in which a staff responded to another staff in a derogatory manner and a client was present at the time. On a different instance, per administrator, staff left the facility early during a shift due to a personal emergency. After staff answered an emergency phone call in front of the clients, staff used foul language during the call. Administrator stated to have discuss the incident with the staff during a change of shift discussion.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview was conducted with direct support staff and a copy of this report, LIC 9099D, and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20250211151603
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: PEOPLE'S CARE COVINA HILLS
FACILITY NUMBER: 198602019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights:(a).. each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidence by:
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Administrator will provide in-service training to staff regarding to staff conduct at the work place and client's personal rights and will submit a copy of log, including topic, duration, and materials to the department by POC due date 2/27/25.
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Based on interviews conducted the licensee did not ensure two staff conducted themselves professionally during work hours and in the presence of the clients which poses a potential risk to the personal rights, health, or safety of the clients in care.
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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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
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
02/11/2025 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250211151603

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:
02/20/2025
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Jorden Seymour - Direct Support Staff TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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3
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9
Facility staff speak inappropriately to clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Jorden Seymour and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/client roster. LPA conducted interviews with 3 staff and 1 client in person. LPA interviewed Administrator, 1 client, and 2 staff over the phone. LPA interviewed client #2(C2) Day Program’s Regional Manager. LPA requested copies of clients #1-2(C1-C2) admissions agreement, face sheet, behavioral assessments, individual service plan, and daily notes from 2/13/25-2/20/25. LPA interviewed San Gabriel Pomona Regional Center’s Service Coordinator and requested copies of individual program plan over the phone.

The investigation revealed the following: Regarding allegation: Facility staff speak inappropriately to clients in care. It is alleged staff is antagonizing and screaming at client in care.
(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20250211151603
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: PEOPLE'S CARE COVINA HILLS
FACILITY NUMBER: 198602019
VISIT DATE: 02/20/2025
NARRATIVE
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Interviews conducted with 2 out of 2 clients revealed, clients stated to have been screamed by staff at the facility. Interviews conducted with staff revealed staff have not screamed at clients in care and attempt to de-escalate behaviors by redirecting and communicating with the clients in care. Per administrator, reports have not been made of observations of staff speaking inappropriate to clients. Interview with Service Coordinator and Day Program’s staff revealed C1 and C2 have a history of fabricating claims about staff when their requests are not being met. Document review revealed C1 and C2’s behaviors escalate upon being redirected or when their request are not met as they will like.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with direct support staff and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5