<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 11/02/2022
Date Signed: 03/04/2023 11:03:46 AM

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
02/22/2022 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220222123311
FACILITY NAME:PEOPLE'S CARE VIOLAFACILITY NUMBER:
198602422
ADMINISTRATOR:ADRIANNA HARBINFACILITY TYPE:
737
ADDRESS:1605 VIOLA PLTELEPHONE:
(909) 671-4184
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:3CENSUS: 3DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:House Lead, Christian RodriguezTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injuries to a client while in care
Staff did not administer a client's medication as prescribed
Staff are inappropriately restrained a client while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
*****This is an amended version of the report dated 11/02/2022. The report was amended to clarify statements and information regarding physical restraints. No other changes have been made to the report. Investigation findings remain the same.*****

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent unannounced visit to further investigate the above-mentioned allegations. LPA met with RBT Marc Marquez and House Lead Christian Rodriguez and explained the reason for the visit. The initial complaint visit was conducted by LPA David Sicairos on 2/23/2022.

During the initial visit, the investigation consisted of the following: LPA Sicairos requested copies of Client & Staff Rosters and conducted a tour of facility including the common areas. LPA also requested copies from Client #1 (C1) file. LPA observed the clients to identify any signs of neglect, abuse, or other immediate health and safety threats. Only 1 client was at the facility during visit. LPA did not observe any immediate health and/or safety concerns during the visit. LPA observed a sufficient supply of perishable and non-perishable foods for the clients in care.

During today’s visit, the investigation consisted of the following: LPA obtained copies of current Staff/Client Roster, Staff interviews, Staff #1-#4 (S1-S4) and Client interviews, Client #1-#3 (C1-C3), review of facility records, general event reports for C1-C3 (Feb 2022) and tour of the facility in common areas. LPA additionally reviewed C1-3's Medication Administration Records (MAR) and collected copies for the months of January 2022 and February 2022.

*****REPORT CONTINUED ON LIC 9099-C*****
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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-20220222123311
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: 11/02/2022
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
Investigation revealed the following: in regard to the allegation: Staff caused injuries to a client while in care. This allegation was investigated by the Investigations Branch (date completed 5/27/2022). Investigator conducted interviews and file reviews and found insufficient evidence to substantiate any sexual abuse involving C1. There were no witnesses to the incident and C1 admitted to fabricating the allegations as she was upset at S2. S1-S2 denied the allegations.

Based on statements, interviews and file reviews conducted by Investigations Branch, there was not enough supportive evidence to corroborate the allegation.



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

Regarding the allegation: Staff did not administer a client's medication as prescribed.

It was alleged that the staff at C1’s home refused to give her AM medications. S1-4 denied the allegation and stated that never happened and highly unlikely to happen. S1 stated that they will never refuse to give medications to clients. S1 indicated that the staff were trained and encouraged to give the medications to C1 when she is not in the mood or in an agitated state. There were incidents where C1 will not take her medications and would trick staff by putting medications in her bra or under the pillow. C1 would sometimes throw medications to staff. S2-4 all stated that they encourage clients to take their medications and not to refuse the medications to them. Their goal is to motivate them to take their medications but if clients refuse, staff will give them space or de escalate situation. S3 indicated that it is the client's right to refuse medications, but staff will talk and remind them that medications are there to help them. C2-C3 stated that they never experienced, seen or heard any staff refusing medications to them. C2 indicated that she gets her medication on time. C1 stated that the allegation never happened and she recanted this allegation already. C1 indicated that the staff gives her all her medications. LPA reviewed C1-C3's Medication Administration Records (MAR) for Jan 2022-Feb 2022 and general events reports (Feb 2022). LPA did not observe any discrepancies or evidence to corroborate 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.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220222123311
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: 11/02/2022
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
*****This is an amended version of the report dated 11/02/2022. The report was amended to clarify statements and information regarding physical restraints. No other changes have been made to the report. Investigation findings remain the same.*****

Regarding the allegation: Staff are inappropriately restrained a client while in care.

LPA's interviews with S1-4 revealed that this allegation did not happen. S1-4 denied that this occurred. S2 stated that she did not use any form of physical restraints to C1 as alleged. Staff are trained to apply different procedures and techniques like Crisis Prevention Intervention (CPI) if client is being physically aggressive. The physical restraint plans and strategies are outlined on the client's behavior support plan which are signed and approved by the authorized representatives and the client. S2 indicated that C1 has a history of making up allegations and then recanting statement. S2 stated that multiple times C1 said that S2 was her favorite staff, but if she doesn’t get S2's attention, it upsets her. S3 stated that if the client is being violent or a threat to himself/herself or the staff, they are encouraged to keep their distance or block or redirect them. S3 stated it is their way of intervention without violence. S3 also stated that the staff talk to the clients and they help out by listening to them as they want attention and be heard. S1 stated that he remembered an incident where C1 reported to the Day Program that she did not know where she got the bruise on her abdomen or what happened, but she recanted her story. S1 stated that paramedics came one day and injected C1's stomach with Narcan. C2-3 stated that they did not hear or see this incident about C1 being restrained. C2-3 stated that they never experienced being restrained in the facility. C1 stated that she remembered reporting this allegation to the Day Program, but she recanted it. C1 stated that she was never restrained by any staff in the facility and the allegation did not happen. C1 indicated that she likes living in the facility and has no issues. LPA reviewed the facility reports and did not observe or found evidence to corroborate this allegation.

Based on the observation, interviews conducted and record reviews, 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 found to be UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was provided to the House Lead, Christian Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3