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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602422
Report Date: 02/13/2023
Date Signed: 02/13/2023 12:08:18 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
02/07/2023 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230207081444
FACILITY NAME:PEOPLE'S CARE VIOLAFACILITY NUMBER:
198602422
ADMINISTRATOR:DANIEL ACEVEDOFACILITY TYPE:
737
ADDRESS:1605 VIOLA PLTELEPHONE:
(909) 671-4184
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:3CENSUS: 3DATE:
02/13/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Huendy Mora, Assistant AdministratorTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Facility did not ensure staff completed required certifications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation - Facility did not ensure staff completed required certifications. LPA arrived unannounced and met with the Assistant Administrator, Huendy Mora, to explain the purpose of the visit.

The investigation consisted of the following:
LPA obtained a copy of the staff roster, client roster, reviewed Staff files and the approved plan of operation. Interviews were held with the Assistant Administrator and 2 Staff.

The investigation revealed the following:
In regards to allegation - Facility did not ensure staff completed required certifications. It is alleged that staff did not obtain CPR certifications before it expired. LPA received a copy of the San Gabriel/Pomona Regional Center Corrective Action Plan which indicated 5 Staff cardiopulmonary resusitation (CPR) certificates were not renewed before it expired.
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: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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-20230207081444
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: 02/13/2023
NARRATIVE
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 LPA reviewed 6 Staff file to ensure current cardiopulmonary resusitation (CPR) training is obtained. The records show that 6 staff CPR certificates are currently valid, however, there was a lapse of time between the annual renewals for 5 Staff. The facility's approved program plan indicates that the verification of annual CPR/first aid certificates are maintained in their files. The staff interviewed today also acknowledged that the CPR certificates are renewed annually and is part of the San Gabriel/Pomona Regional Center's requirement for this home.

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

An exit interview was conducted. The Plan of Corrections were reviewed and developed with the assistant administrator. A copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230207081444
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: 02/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/28/2023
Section Cited
CCR
80022(k)
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80022 Plan of Operation (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so.
This requirement is not met as evidenced by:
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The Administrator shall ensure that all the direct care staff have annual CPR training as part of their program plan. The proof of all current CPR certificates for staff are provided to LPA by POC due date 2/28/23.
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Based on interviews and record review, there were 5 staff who had a lapse of time between their annual CPR certificates renewals which poses a potential health and safety risk to clients 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: 02/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3