198602422-4-28-2026-28-AS-LHIS-DTZMVC-20260512095630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 04/28/2026
Date Signed: 04/28/2026 02:23:43 PM

Unsubstantiated

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
04/21/2026 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260421123907

FACILITY NAME:	PEOPLE'S CARE VIOLA		FACILITY NUMBER:	198602422
ADMINISTRATOR:	JASMINE ZAMORA		FACILITY TYPE:	737
ADDRESS:	1605 VIOLA PL		TELEPHONE:	(909) 671-4184
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	3	CENSUS: 3	DATE:	04/28/2026
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Vanessa Garcia - Asst. Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not report incidents in a timely manner.
Licensee does not ensure staff are CPR certified.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit regarding the above stated allegations. LPA met with Vanessa Garcia, Asst. Administrator and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the staff/client rosters, Facility, Staff and Client #1 (C1) - Client #2 (C2) pertinent files related to the investigation and San Gabriel Pomona Regional Center Corrective Action Plan (CAP) LPA interviewed Staff #1-Staff #4 (S1-S4) and Client #2 (C2). Client #1 (C1) was hospitalized; therefore not interviewed and attempted to interview Staff #5 (S5) by phone, but no response received. ***CONTINUED ON LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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-20260421123907

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 VIOLA	FACILITY NUMBER: 198602422
	VISIT DATE: 04/28/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff did not report incidents in a timely manner. It is alleged that staff failed to submit (2) SIRs for incidents involving C1 on 10/17/2025 within the required 48 hours time frame. Staff interviewed stated C1 requested to go to the ER twice on Friday, on October 17, 2025, once for discomfort in a sensitive area and once for hearing issues. Staff confirmed these incidents were reported in writing to the Regional Center on Monday, October 20, 2025. Staff interviewed also stated they receive training on incident reports every few months. Review of the Unusual incident/injury reports (SIR) confirmed that both incidents involving C1 took place on Friday, October 17, 2025 and SIRs were submitted to CCLD the following Monday, October 20, 2025, aligning with Title 22 regulations 80061 Reporting Requirements requiring notification by the next working day during its normal business hours. Since the incident took place on a Friday, submitting the report on Monday complies with this regulatory requirement. Therefore, the allegation regarding untimeliness is unsubstantiated.

Allegation: Licensee does not ensure staff are CPR certified. It is alleged that S3’s First Aid/CPR expired on 06/15/2025 and was renewed on 06/17/2025, two days late. However, S3 worked from 10 pm on 06/15/2025 to 2 pm (06/16/2025) and on 06/17/2025 from 9am -12 pm. Staff interviewed stated they are qualified to perform first aid and CPR, as necessary. Staff indicated that the administrator sends out reminders to staff for training certification renewals. However, S3 stated that they failed to renew their certification due to busy schedules and simple oversight. When the actual expiration date was discovered, S3 promptly renewed it. Documents reviewed revealed that (4) other staff scheduled to work with S3 between 06/15/2025-06/17/2025, have current first aid/CPR training. Based on Title 22 Health & Safety Code 1569.618(c)(3), the administrator shall schedule and ensure that at least one staff member who has First aid/CPR training is on duty and on the premises at all times. Therefore, there is insufficient evidence to corroborate the allegation.

Based on interviews conducted, as well as reviewed files and documentation, there was not enough supportive evidence to concur with the reported allegations.

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 conducted and a copy of this report was provided to Vanessa Garcia, Assistant Administrator.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5

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
04/21/2026 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260421123907

FACILITY NAME:	PEOPLE'S CARE VIOLA		FACILITY NUMBER:	198602422
ADMINISTRATOR:	JASMINE ZAMORA		FACILITY TYPE:	737
ADDRESS:	1605 VIOLA PL		TELEPHONE:	(909) 671-4184
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	3	CENSUS: 3	DATE:	04/28/2026
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Vanessa Garcia - Asst. Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not pick up resident in a timely manner after hospitalization.
Staff did not follow the facility IPP resulting in client ingesting a foreign object.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 28-AS-20260421123907

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 VIOLA	FACILITY NUMBER: 198602422
	VISIT DATE: 04/28/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff did not pick up resident in a timely manner after hospitalization. It is alleged that on 02/28/2026, C1 reported arm pain and threats of self-harm, leading to a 72-hour hold at the hospital by the PET team. The hold ended on 03/02/2026 at 10:30 am, but C1 was not picked up around 10:30pm due to staff shortages. Staff interviewed corroborated the allegation stating that C1 was taken to the hospital on 02/28/2026. Due to C1's self-harm statements, the PET team assessed C1 and was placed on a 72-hour hold, which was lifted by the psychiatrist on 03/02/2026, at about 10:30am. The hospital called to request a pick-up around 11am, but the administrator stated they had only one staff member available until 3pm. The hospital called back at 3pm but was told there were still no staff available. C1 was finally picked up around 10:30pm. Documents reviewed revealed that on 03/01/26 at 6:37am, administrator told staff assigned to C1 not to come in on 03/01/2026 and 03/02/2026 due to C1 on a 72-hour hold, indicating a lack of staff to pick up C1 in a timely manner. Based on interviews, C1 should have been picked up immediately or within a reasonable time frame, not 12 hours later. Therefore, there is sufficient evidence to corroborate the allegation.

Allegation: Staff did not follow the facility IPP resulting in client ingesting a foreign object. It is alleged that staff failed to provide supervision and failed to implement the Individual Behavior Support Plan/IBSP for C1 and C2 on (2) separate occasions. Staff interviewed corroborated the allegation and confirmed that on 02/21/2026, C2 went to the park with a staff member (later resigned from their position), who was reportedly on the phone. C2 admitted to inhaling marijuana wax vape while staff was not watching. Another incident occurred on 02/28/26, involving C1, who reported arm pain and later threatened self-harm while saying they had swallowed a metal object. C1 was then transported to the hospital for evaluation, where it was confirmed that C1 had swallowed a dime. Although the staff reported maintaining a line of sight, they could not explain how C1 swallowed the dime, indicating staff did not maintain proper supervision. C2 corroborated the allegation. Documents reviewed as well as interviews revealed that staff did not supervise C1-C2 adequately to ensure their safety. Therefore, there is sufficient evidence to corroborate the allegation.

Based on interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was provided to Vanessa Garcia, Asst. Administrator along with the Appeal Rights.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 28-AS-20260421123907

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 VIOLA	FACILITY NUMBER: 198602422
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/05/2026 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator to ensure that clients have the right to be treated with dignity, humanity, and safe/comfortable accommodation. Administrator to train all staff and send in service training tn client’s rights and the event hospital/psychiatric holds/day that the client needs to be picked up.
	8 9 10 11 12 13 14	Based on interviews, records review, the Administrator did not comply with the section cited above in which C1 was not picked up in a timely manner afer hospitalization due to lack of staffing which poses a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14	Training log to be submitted to CCLD/LPA by POC due date,
Type B 06/05/2026 Section Cited CCR 85068.2(b)(2)	1 2 3 4 5 6 7	85068.2 Needs and Services Plan (b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include: (2) Facility plans for providing services to meet the individual needs identified above. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator to provide training to all staff and submit in service training log for proper client supervision to CCLD/LPA by POC due date.
	8 9 10 11 12 13 14	Based on interviews, records review, the Administrator did not comply with the section cited above in which staff did not adequately supervise C1-C2 to prevent them from harm and inappropriate ingestion which poses a potential health, safety or personal rights risk to clients in care.	8 9 10 11 12 13 14

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: Lisa Hicks
LICENSING EVALUATOR NAME: Bennette Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5