198602422-12-23-2022-28-AS-TVAO-CMK2AF-20221228161327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 12/23/2022
Date Signed: 12/23/2022 01:32:28 PM

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
06/06/2022 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220606120240

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:	12/23/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	House Lead Chris Rodriguez		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Resident was sexually assaulted 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 above mentioned allegation. The initial complaint visit was conducted by LPA Glenn Trueman on 6/7/22. Investigator, Jose Santana investigated further.

LPA met with House Lead Chris Rodriguez and explained the reason for the visit.The investigation consisted of the following: Interviews were conducted with Client #1 (C1), 6 staff including administrator, and representatives from San Gabriel/Pomona Regional Center. Facility incident reports were reviewed along with C1’s file and police report from Pomona Police Department. Investigation consisted of the following: It’s alleged Staff #1 (S1) sexually assaulted C1 the morning of 6/5/22. S1 was interviewed and recanted the allegation. C1 indicated he/she was upset with S1 and made the story up. S1 (Alleged suspect) was interviewed and denied the allegation. Other staff interviewed denied having any knowledge of the incident.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

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-20220606120240

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: 12/23/2022

NARRATIVE

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C1 was actually being supervised by another 1:1 staff on 6/5/22 and it was not S1. Hospital records were reviewed. There was no indication of sexual assault due to C1 refusing an exam. The police report did not have evidence that a crime occurred, and the investigation was closed.

Based on the information obtained and C1 recanting the allegation, 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: 12/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022

LIC9099 (FAS) - (06/04)

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