198602123-5-25-2023-28-AS-RORN-CT2MGP-20230622093612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602123
Report Date: 05/25/2023
Date Signed: 05/25/2023 03:37:52 PM

Unsubstantiated

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
05/19/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230519092738

FACILITY NAME:	PEOPLE'S CARE CAMERON		FACILITY NUMBER:	198602123
ADMINISTRATOR:	MARGIE KIMBLE		FACILITY TYPE:	735
ADDRESS:	2441 CAMERON AVE		TELEPHONE:	(626) 732-3500
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	4	CENSUS: 3	DATE:	05/25/2023
		UNANNOUNCED	TIME BEGAN:	01:02 PM
MET WITH:	Abigail Reano - House Manager		TIME COMPLETED:	03:52 PM

ALLEGATION(S):

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Staff denied a client from having access to the restroom while in care.
Staff let a client be soiled while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met Abigail Reano (House Manager) and explained the reason for the visit.

The investigation consisted of the following: LPA Mora obtained copies of the client and staff rosters, and interviewed House Manager, Staff 1 - Staff 5 (S1 - S5), Client 1 - Client 3 (C1 - C3) and attempted to interview regional center representative. LPA also obtained a copy of the daily log which is time stamped with 05/18/23 5:18am.

The investigation revealed the following: regarding the allegations "staff denied a client from having access to the restroom while in care” and "staff let a client be soiled while in care", it is alleged that S1 instructed C1 not to leave the room after midnight causing C1 to stay in the room and having a bowel and urine-related accident. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

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-20230519092738

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 CAMERON	FACILITY NUMBER: 198602123
	VISIT DATE: 05/25/2023

NARRATIVE

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Interview with the House Manager revealed the following was documented by NOC shift on the daily log: NOC shift staff started their shift at 10pm. Upon arrival, the NOC shift checked on C1 and C1 was asleep. Another room check was done at 11:30pm and C1 was still asleep. At 12:20am of 05/18/23, NOC shift observed that C1's room door was opened and the lights were on. They found C1 standing naked in front of his TV and there was feces on the floor and on C1's leg. Staff offered the client a showered and client accepted. Client requested his PRN medication for stomach relief and went back to bed. Staff interviewed denied the allegations and stated that they have not instructed clients to not leave their rooms or prevented them from using the restrooms. They also stated that they assist clients in showering or cleaning up as soon as they find out that they have soiled themselves. Interview with C1 revealed that C1 did soiled self because a staff instructed C1 not to leave the room at midnight and therefore C1 was not able to go to the restroom. C1 confirmed that the NOC shift staff did assist in cleaning up and showering when they found out about the accident. During this interview, C1 did not want to identify the alleged staff. Interview with C2 revealed that it was not S1 that gave those instructions to the clients and that it was S2. Interview with C3 revealed that no staff has given those instructions to any of the clients and that staff do assist them quickly whenever they have an accident.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023

LIC9099 (FAS) - (06/04)

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