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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602123
Report Date: 12/12/2025
Date Signed: 12/12/2025 07:09:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
11/06/2025 and conducted by Evaluator Sanjay Vaid
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251106090855
FACILITY NAME:PEOPLE'S CARE CAMERONFACILITY NUMBER:
198602123
ADMINISTRATOR:MARGIE KIMBLEFACILITY TYPE:
735
ADDRESS:2441 CAMERON AVETELEPHONE:
(626) 732-3500
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:4CENSUS: 3DATE:
12/12/2025
UNANNOUNCEDTIME BEGAN:
10:28 AM
MET WITH:Administrator- Filimon GebremichaelTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff engaged in a physical altercation with resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sanjay Vaid conducted a subsquential unannounced visit to deliver finding for the above-mentioned allegation. LPA Vaid met with Administrator- Filimon Gebremichael and discussed the findings. LPA Vaid and administraor toured the facility and did not observe any health and safety concern.

On 11/10/25, Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit regarding the above allegation. LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster (LIC 500), Staff#1 - 3 interviews (S1 – S3), Client#1-3 (C1-C3) interviews, Copies of Client#1-3 (C1-C3): Face sheet, Individual Program Plan (IPP), Emergency Contact Information.

The investigation revealed the following:

CONTINUED ON 9099C.........
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
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 3
Control Number 28-AS-20251106090855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PEOPLE'S CARE CAMERON
FACILITY NUMBER: 198602123
VISIT DATE: 12/12/2025
NARRATIVE
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Regarding the allegation: Staff engaged in a physical altercation with a client. It is alleged that Staff #1(S1) engaged into a physical altercation with a client#1 (C1) after the C1 got a personal food item from their personal cubby. One (1) of four (4) staff interviewed stated they witnessed S1 yelling, chasing C1 around the yard and physically altercation with C1. One (1) of three (3) clients stated that they were witness to S1 chasing and yelling at C1 around the home and into the backyard and striking C1. Based on interviews with staff and clients which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

California Code of Regulations, (Title 22, Division & Chapter number 6), are being cited on the attached LIC 9099D.

This report 9099 and 9099C and 9099D and appeals were provided to Administrator -Filimon Gebremichael.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20251106090855
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE CAMERON
FACILITY NUMBER: 198602123
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2025
Section Cited
CCR
80072(a)(3)
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Personal Rights80072 (a)Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
This requirement was not met as evidence by:
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Administrator to conduct In-service training on Clients Personal Rights by 12/19/2025.
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S1 attempted to deny C1 their personal food item, resulting in S1 striking C1.
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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.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3