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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 12/16/2022
Date Signed: 12/16/2022 12:33:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/06/2022 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20221206162232
FACILITY NAME:PEOPLE'S CARE FERREROFACILITY NUMBER:
198602544
ADMINISTRATOR:AARON EATONFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:4CENSUS: 3DATE:
12/16/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Angela Williams AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff hit resident
INVESTIGATION FINDINGS:
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On 12/16/22 at 10:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Angela Williams (Administrator) and explained the purpose of the visit.

During today’s visit LPA and Staff #2(S2) toured the facility. LPA obtained resident/ staff roster, Incident report dated 9/22/22, Staff #1(S1) notes, and Client #1(C1) behavioral plan from San Gabriel Regional Center. LPA also interviewed: Administrator and a total of two (4) staff who shall be referred to as S1, S2, S3 and S4. LPA interviewed a total of 1 client who shall be referred to as C1. LPA attempted to interview C2 and C3 but was unable to complete the interview due to limited verbal communication.

Report continued 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
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 2
Control Number 28-AS-20221206162232
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PEOPLE'S CARE FERRERO
FACILITY NUMBER: 198602544
VISIT DATE: 12/16/2022
NARRATIVE
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The investigation reveals the following: Regarding " Staff hit Resident", it is alleged that the C1 witness S1 punching C2 in the face twice. The administrator started working after incident and has limited knowledge of the incident. 2/4 staff stated they did not witness the incident and C1 has a history of fabricating stories. 1/4 staff witness the incident and stated C2 was not punched but slipped and fell in rest room. The staff further stated that C1 was not around when the incident happened. 1/4 staff stated they did not witness the incident but C1 confessed to them that S1 never punched C2. 4/4 staff confirmed never witnessing staff hitting residents at the facility. During the interview with C2, the allegation was retracted. C2 stated that S1 never punched C2. LPA reviewed C1 IPP-behavioral plan and noted that C1 has a history of fabricating stories.

Based on LPA's observation, interviews and file review the investigation revealed: 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 allegations are UNSUBSTANTIATED.

Exit interview conducted with Angela Williams and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2