198602422-12-19-2022-28-AS-TVAO-CMCW3Z-20221222155645

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 12/19/2022
Date Signed: 12/19/2022 09:54:57 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
07/26/2022 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220726141942

FACILITY NAME:	PEOPLE'S CARE VIOLA		FACILITY NUMBER:	198602422
ADMINISTRATOR:	ADRIANNA HARBIN		FACILITY TYPE:	737
ADDRESS:	1605 VIOLA PL		TELEPHONE:	(909) 671-4184
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	3	CENSUS: 3	DATE:	12/19/2022
		UNANNOUNCED	TIME BEGAN:	09:27 AM
MET WITH:	Administrator Daniel Acevedo		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility staff members hit client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint visit to deliver findings for the allegation listed above. LPA met with Administrator Daniel Acevedo and explained the reason for the visit. The initial complaint visit was conducted by LPA Trueman on 7/27/22. A subsequent complaint visit was conducted by LPA Vasallo on 7/28/22.

The investigation consisted of the following: Interviews were conducted with 2 out of the 3 clients and with 3 staff. A representative from San Gabriel/Pomona Regional Center was also Interviewed. The facility was toured and facility incident reports were reviewed.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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-20220726141942

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: 12/19/2022

NARRATIVE

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The investigation revealed the following: It’s alleged facility staff hit a client. Facility incident report indicates that on 7/24/22 at approximately 9:20 am, staff and clients were discussing a possible outing for that day. Staff reminded clients that chores had to be completed prior to going on an outing. Client #1 (C1) refused to do chores and indicated he/she didn’t want to go on an outing. Staff #1 (S1) went to C1’s room to discuss the outing and C1 became physically aggressive with S1 by pushing and eventually hitting S1 in the chest. At that time S1 and Staff #2 (S2) performed a physical hold on C1 and assisted C1 to his/her room. C1 continued to attempt to hit and spit on staff. After approximately 45 seconds C1 calmed down and the physical hold was released. No injuries were noted on C1.

Interviews were conducted with C1 and Client #2 (C2). C1 confirmed the altercation with staff and indicated he/she had a small bruise on his/her face. C1 indicated staff didn’t hit him/her. C1 thinks the injury could have come from hitting a staff’s elbow during the physical hold staff conducted. C2 indicated he/she gets along with all the staff and there have been no issues. S1 and S2 confirmed the incident and denied hitting C1. The facility was toured, and it was confirmed the facility does not have any cameras. The representative from San Gabriel/Pomona Regional Center indicated they also investigated and did not find any proof the incident occurred. Based on the information obtained the allegation is unsubstantiated.

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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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