198602544-5-4-2023-28-AS-FFIS-CRP233-20230509170139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 05/04/2023
Date Signed: 05/04/2023 12:53:33 PM

Substantiated

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
09/22/2022 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220922103833

FACILITY NAME:	PEOPLE'S CARE FERRERO		FACILITY NUMBER:	198602544
ADMINISTRATOR:	AARON EATON		FACILITY TYPE:	735
ADDRESS:	431 FERRERO LN		TELEPHONE:	(909) 287-3557
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	4	CENSUS: 3	DATE:	05/04/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Angela Williams (Administrator)		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff hit resident.

INVESTIGATION FINDINGS:

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***This LIC9099 report supersedes LIC9099 dated 09/26/22.***

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced subsequent complaint investigation at the facility. LPA met with Angela Williams (Administrator) and explained the purpose of the visit.

During today's visit, LPA obtained a copy of the Staff/Client Rosters, LPA attempted to interview Staff #3, interviewed Client #2 in the dining area, attempted to interview Client #1, #2 and interviewed facility District Manager in the dining area.

During a visit conducted 09/26/22, LPA obtained a copy of the Staff/Client Rosters, staff statements and interviewed staff #1, #2 to staff #4 in the office.

Continue to LIC9099C....

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

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-20220922103833

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/05/2023 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature,	1 2 3 4 5 6 7	Licensee shall provide additional training to all Direct Support Staff pertaining to Title 22 section 80072 (Personal Rights) and provide proof to the department by the POC date.
	8 9 10 11 12 13 14	including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by: Staff #2 witnessed staff #3 hit client #1 with a twirled towel on the shoulder, back, stomach and face.	8 9 10 11 12 13 14	Note: POC already cleared on 10/06/22. This LIC9099D supersedes LIC9099D dated 09/26/22.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220922103833

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: 05/04/2023

NARRATIVE

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In regards to the allegation: Staff hit resident. LPA interviewed staff #2 who witnessed staff #3 hit client #1 with a twirled towel on the shoulder, back, stomach and face.

Based on LPA's interviews and staff statement 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 are being cited on the attached LIC 9099D. The attached LIC 9099D supersedes LIC9099D dated 09/26/22.

Exit interview conducted with Angela Williams and a copy of this report and appeal rights provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023

LIC9099 (FAS) - (06/04)

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