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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 05/23/2024
Date Signed: 05/23/2024 02:15:02 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
01/11/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240111151158
FACILITY NAME:PEOPLE'S CARE VIOLAFACILITY NUMBER:
198602422
ADMINISTRATOR:HUENDY MORAFACILITY TYPE:
737
ADDRESS:1605 VIOLA PLTELEPHONE:
(909) 671-4184
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:3CENSUS: 2DATE:
05/23/2024
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Huendy Mora, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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The staff did not provide a safe environment for client.
Staff left client unsupervised.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegations listed above. LPA met with Administrator, Huendy Mora and explained the purpose for the visit.

The investigation consisted of the following:
On 1/12/24, LPA Chan conducted the initial visit. LPA obtained copies of staff roster, client roster, and documents pertaining to Client #1 (C-1) and Staff #1 (S-1). LPA interviewed the administrator and 2 Staff.
Interviews with additional staff members and the San Gabriel/Pomona Regional Center Quality Assurance Specialist were held on different dates.

The investigation revealed the following:
Allegations – Staff did not provide a safe environment for the client, and Staff left the client unsupervised. It is alleged that Staff #1 (S1) took Client #1 (C1) to a friend’s house instead of the preferred outing and was left unsupervised.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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 5
Control Number 28-AS-20240111151158
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 VIOLA
FACILITY NUMBER: 198602422
VISIT DATE: 05/23/2024
NARRATIVE
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The San Gabriel/Pomona Regional Center (SGPRC) also investigated these allegations, and a copy of their Corrective Action Plan was received. Based on interviews and written statements, it was revealed that S1 took C1 to a different location and not one of the client’s chosen outings. Per the administrator, C1 will write down 3 locations daily that he/she would like to go to weekly.

On 12/24/23, S1 and C1 supposedly went to the Hollywood Walk of Fame, which was not among the chosen or preferred outings. The staff did not check the list to confirm the destination site. LPA interviewed S1 who denied taking C1 to a friend's home versus the Hollywood Walk of Fame. However, another staff and C1 confirmed that S1 and the client went to a person's house. The administrator also interviewed S1 who could not provide any evidence of the visit to Hollywood Walk of Fame.

S1 admitted to leaving C1 unattended for a few minutes to use the restroom during their outing. The outing was one-on-one with the client; therefore, no other staff was in attendance to supervise C1. Based on information gathered, S1 did not provide a safe environment for the C1, who may engage in self-injurious behaviors if the client is not directly under supervision.

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


An exit interview was conducted. A copy of this report, Plan of Correction, and appeal rights were given to the administrator.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20240111151158
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 VIOLA
FACILITY NUMBER: 198602422
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/24/2024
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a)...each client shall have personal rights which include, but are not limited to, the following: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met as evidenced by:
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The licensee shall provide in-service training to ensure the clients are going to approved outings and plans to keep the client safe.

This POC has been cleared as of today.
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Based on interviews and records review, the licensee did not ensure Client #1 was provided a safe environment during the outing which poses an immediate health, safety, and personal rights risk to client in care.
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Type A
05/24/2024
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidenced by:
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The licensee shall provide an in-service training to develop a plan to ensure Client #1 is in the line of sight at all times.

This POC has been cleared as of today.
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Based on interviews and document review, the licensee did not ensure that Client #1 is supervised at all times which poses an immediate health and safety risk to client 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: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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
01/11/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240111151158

FACILITY NAME:PEOPLE'S CARE VIOLAFACILITY NUMBER:
198602422
ADMINISTRATOR:HUENDY MORAFACILITY TYPE:
737
ADDRESS:1605 VIOLA PLTELEPHONE:
(909) 671-4184
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:3CENSUS: 2DATE:
05/23/2024
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Huendy Mora, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
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9
Staff bribed client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver findings for the allegation listed above. LPA met with Administrator, Huendy Mora and explained the purpose of the visit.

The investigation consisted of the following:
On 1/12/24, LPA Chan conducted the initial visit. LPA obtained copies of staff roster, client roster, and documents pertaining to Client #1 (C-1) and Staff #1 (S-1). LPA interviewed the administrator and 2 Staff.
Interviews with additional staff members and the San Gabriel/Pomona Regional Center Quality Assurance Specialist were held on different dates.

Allegation - Staff bribed Client. It is alleged that Staff #1 (S1) bribed Client #1 (C1) with a black mild cigar and Chinese food to skip the outing. C1 was also asked to say that the outing took very long due to an accident on the freeway on the way back.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
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-20240111151158
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 VIOLA
FACILITY NUMBER: 198602422
VISIT DATE: 05/23/2024
NARRATIVE
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LPA interviewed S1 who denied bribing the client with a black mild or telling C1 to lie about their visit. The administrator was made aware of this allegation after interviewing C1. However, none of the 6 staff members interviewed could confirm this allegation. Interview with Staff #2 indicated that this incident was reported by C1 and not directly by S1. Staff #3 verified the information received was hearsay. Although C1 indicated this incident took place, there were no other witnesses to confirm this 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.



An exit interview was conduct. A copy of this report along with the appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5