198602080-9-29-2022-28-AS-RORN-CJVR7P-20221004124639

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602080
Report Date: 09/29/2022
Date Signed: 09/29/2022 01:54:51 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
09/13/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220913145713

FACILITY NAME:	HOURGLASS HOME		FACILITY NUMBER:	198602080
ADMINISTRATOR:	MARIA BINOTAPA		FACILITY TYPE:	735
ADDRESS:	1121 HOURGLASS PLACE		TELEPHONE:	(909) 631-8521
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 6	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Maria Binotapa		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff had a physical altercation with resident resulting in resident becoming injured

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Maria Binotapa and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 9/14/22, LPA Gonzalez collected copies of Staff and Client rosters. LPA also conducted a tour of entire facility inside and out with Administrator Maria Binotapa. LPA observed three (3) clients in the facility at the time of the visit and observed the clients to identify any signs of neglect, abuse or other immediate Health and Safety threats. LPA did not observe any immediate Health & Safety concerns during the visit. LPA reviewed Client 1 (C1) file and collected documents pertinent to the investigation. LPA interviewed Administrator Maria Binotapa and C1. C2-3 were not interviewed due to clients being asleep during the visit. On 9/29/22, LPA Gonzalez interviewed C2-6, Staff 1-3 (S1-3),

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

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-20220913145713

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: HOURGLASS HOME	FACILITY NUMBER: 198602080
	VISIT DATE: 09/29/2022

NARRATIVE

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Social Vocational Services Day Program Staff (DPS) by telephone and San Gabriel Pomona Regional Center (SGPRC) Service Coordinator Denise Mendoza Ojeda by telephone.

Investigation revealed the following: Regarding allegation, Staff had a physical altercation with resident resulting in resident becoming injured, it is alleged that bruising was observed on C1's legs (left shin and upper right calf) on 9/13/22 by DPS and when C1 was asked how they sustained the injuries C1 reported that they had an altercation with a facility staff on 9/9/22. C1 was allegedly sitting at the table with other facility clients when staff allegedly came up to C1 yelling at them. C1 reacted by hitting the staff for yelling at them and also tore the staff's clothing. C1 was allegedly then picked up by the staff and thrown down to the ground causing the injuries. C1's reported injuries were large bruises on their left shin, under the knee and on their right calf near the side of their leg. The bruising was reported to be green and may have been in the healing stage.

Interviews conducted with Administrator Binotapa and S3 revealed that on 9/9/22, C1 had a behavior during which C1 began hitting Administrator due to C1 becoming upset over comments made by C4. C4 told administrator about a conversation that occurred between C1 and C4 in their room the night before and C1 became extremely upset when administrator attempted to tell C1 that their behavior and statements were inappropriate. Staff stated that C1 became so upset that they began hitting the administrator and also ripped the administrator's clothing and at the same moment that the clothing was ripped by C1, the administrator then lost their balance as well as C1. C1 fell off the chair that they were semi-sitting on while they were hitting the administrator and was subsequently hit by boxes located on the side of the table as they fell and the administrator was also hit by the chair that C1 was sitting on. Administrator stated that C1 did sustain bruising from the impact of the fall and impact with the boxes and that she sustained a cut on her knee when C1 fell off the chair and one of the chair legs hit her on the knee causing a cut which bled. Administrator and S3 stated that C1 was very upset and screamed out obscenities as well as threatening comments. Administrator redirected C1 and stated that C1 eventually became very apologetic. Interviews with C2-6 revealed that C1 was the aggressor on 9/9/22 and did hit and rip administrator's clothing due to becoming mad about comments made by C4 when they were sitting in the dining room table. C1 admitted that they lied and were very sorry to have made the story up as they would never want to get the administrator in trouble because she is a very good administrator and takes very good care of the clients. Interviews conducted with Social

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220913145713

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: HOURGLASS HOME	FACILITY NUMBER: 198602080
	VISIT DATE: 09/29/2022

NARRATIVE

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Vocational Services Day Program Staff (DPS) and SGPRC Service Coordinator Denise Mendoza Ojeda revealed that C1 does fabricate stories and then recants. C2-6 stated that C1 can be verbally aggressive and makes inappropriately aggressive and threatening comments to them. C6 stated that C1 makes racial comments to them. C1-6 stated that facility staff are nice and take very good care of them and also stated
that they are happy at the facility as well as with all the services they receive at the facility. C1-6 stated that staff have never yelled at them or ever physically abused them. C1 stated that they were never picked up and thrown to the ground and admitted to making that up. Administrator and S1-3 denied ever yelling at any facility clients and also denied every physically abusing any facility client. Administrator stated that she immediately reported the incident to San Gabriel Pomona Regional Center Service Coordinator Denise Mendoza Ojeda who conducted interviews with her and with the clients by telephone. Interview conducted with Service Coordinator Denise Mendoza Ojeda revealed that all her client interviews were consisted and all clients revealed that C1 had been the aggressor against the staff on 9/9/22. Administrator also reported the incident to Community Care Licensing Division (CCLD).

LPA's review of C1's Individual Program Plan (IPP) corroborated the information provided by both SGPRC staff, DPS, and interviews conducted with facility staff and clients which revealed that C1 fabricates stories, is verbally/ physically aggressive towards peers, and makes threats while attempting to act on the threats.

During facility tour, LPA observed clients in their rooms sleeping, in the living room watching television and also participating in activities and did not observe anything of concern. LPA observed the facility to be clean during the visits conducted on 9/14/22 and 9/29/22 and did not observe any items obstructing any doors or passageways. Based on statements gathered from interviews conducted with staff, SGPRC staff, Social Vocational Services Day Program Staff (DPS), LPA record review and observations, there was not enough supportive evidence to concur with the reported allegation.

Although the allegation 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.

Exit interview held. A copy of the report was provided to Administrator Maria Binotapa.

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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