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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602123
Report Date: 01/04/2024
Date Signed: 01/04/2024 05:47:55 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
06/08/2023 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20230608084241
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: 2DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Margie Kimble, administratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff physically abused resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted a subsequent unannounced visit to continue the investigation and deliver the complaint finding of the allegation at the facility today. LPA explained the purpose of today's visit to administrator Margie who assisted with this visit.

On 06/08/23, Licensing Program Analyst (LPA) Long conducted the initial unannounced investigation for a health and safety check at the facility. LPA met with program director Margie Kimble during the visit.

On 01/04/24, LPA Tao conducted a subsequent visit for investigation and conducted additional interviews with staff and clients.

The investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #6 (S6); interviews of clients from client #1 (C1) through client #3 (C3); facility record reviews, and a facility tour. LPA obtained copies of staff and client rosters; and client files for client #1 (C1) with relevant information.
(- continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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 2
Control Number 28-AS-20230608084241
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 CAMERON
FACILITY NUMBER: 198602123
VISIT DATE: 01/04/2024
NARRATIVE
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The investigation revealed the following:

In regard to the allegation of staff physically abused resident, it was alleged that staff hit client#1 (C1) on the back of client’s head with a closed fist. The investigation revealed the following. All three (3) clients interviewed could not corroborate the allegation. Clients indicated staff did not hit them. Staff interviews were conducted on staff from staff #1 (S1) to staff#6 (S6). All staff denied the allegation. Staff indicated that is facility policy to have zero tolerance on any forms of abuses. Per client record reviews, client#1 has a documented history of fabricating false statements. Besides, C1 did not report being physically abused by staff while residing at the facility. During the visit, LPA observed that staff were nice and respect clients.

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

An exit interview was conducted with administrator, Margie. Findings were discussed during the exit conference. A copy this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2