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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 09/08/2023
Date Signed: 09/08/2023 12:06:23 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
07/05/2022 and conducted by Evaluator Tena Herrera
COMPLAINT CONTROL NUMBER: 28-AS-20220705163858
FACILITY NAME:PEOPLE'S CARE FERREROFACILITY NUMBER:
198602544
ADMINISTRATOR:AGAIOTUPU POUESIFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:4CENSUS: 3DATE:
09/08/2023
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:George Aliimatafitatafi - House ManagerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff caused injury to resident's hand.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with George Aliimatafitatafi - House Manager and explained the purpose of the visit.

Investigation consisted of the following: During the initial visit conducted on 07/06/22, LPAs Long & Calderon conducted a health and safety check. LPAs toured the facility and observed food supply. No immediate health and/or safety concerns were observed.

Investigation revealed the following:
In regards to the allegation “staff caused injury to resident’s hand”.
It is alleged that Resident #1 (R1) had been taken via ambulance to the Hospital due to swallowing some screws. While at the Hospital, R1 also alleged that a facility staff member had tried to break their hand on 07/01/22. This allegation was investigated by Investigator Miles with the Investigations Branch. Victim, witnesses, and staff member interviews were conducted. (Continued on 9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
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 5
Control Number 28-AS-20220705163858
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 FERRERO
FACILITY NUMBER: 198602544
VISIT DATE: 09/08/2023
NARRATIVE
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 On 07/01/22 Staff #1 (S1) and Staff #2 (S2), performed two Crisis Prevention Interventions (CPI) on R1. Interviews conducted revealed that R1 complained about pain to his hand, however R1 was never transported to the hospital. S1 and S2 were also aware of R1’s pain to his hand, however, did not seek medical attention for R1. On 07/04/22, 3 days after the CPI’s were performed, R1 was transported to the Hospital for evaluation. Hospital took X-Rays and discovered a “spiral fracture of the right 1st metacarpal bone”.

An immediate $1000 Civil Penalty is being issued during today’s visit as a previous licensing report was issued on 5/4/23 giving notice of the same violation.

At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1548(f)(1)(A) and may be assessed at a later date.

Based on LPA's observations and interviews which were 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 are being cited on the attached LIC 9099D.

Exit interview held and a copy of this report was provided along with appeal rights to Administrator Angela Williams.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/05/2022 and conducted by Evaluator Tena Herrera
COMPLAINT CONTROL NUMBER: 28-AS-20220705163858

FACILITY NAME:PEOPLE'S CARE FERREROFACILITY NUMBER:
198602544
ADMINISTRATOR:AGAIOTUPU POUESIFACILITY TYPE:
735
ADDRESS:431 FERRERO LNTELEPHONE:
(909) 287-3557
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:4CENSUS: 3DATE:
09/08/2023
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:George Aliimatafitatafi - House ManagerTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Resident was sexually abused while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with George Aliimatafitatafi - House Manager and explained the purpose of the visit.

Investigation consisted of the following: During the initial visit conducted on 07/06/22, LPAs Long & Calderon conducted a health and safety check. LPAs toured the facility and observed food supply. No immediate health and/or safety concerns were observed.

Investigation revealed the following:
in regards to the allegation “Resident was sexually abused while in care”, it is alleged that Resident #1 (R1) is being raped by facility staff. This allegation was investigated by Investigator Miles with the Investigations Branch. Victim, witnesses, and staff member interviews were conducted. Staff #1 (S1) allegedly inappropriately touched R1. Interviews conducted revealed that R1 has a history of making false allegations of being inappropriately touched and being raped. (Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20220705163858
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 FERRERO
FACILITY NUMBER: 198602544
VISIT DATE: 09/08/2023
NARRATIVE
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S1 denied he inappropriately touched or raped R1. Based on interviews conducted, there is insufficient evidence to support the allegation of sexual abuse.

Based on statements and interviews conducted with staff, clients and review of facility file records, there was not enough supportive evidence to concur with the reported allegation. 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.

Exit interview held and a copy of this report was provided to Administrator Angela Williams.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 28-AS-20220705163858
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 FERRERO
FACILITY NUMBER: 198602544
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
09/09/2023
Section Cited
CCR
80072(a)(3)
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(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, 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.
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Administrator to ensure all client’s have personal rights. Administrator to submit written plan indicating how facility will meet this regulation. In addition, facility will retrain all staff in CPI within the next 2 weeks and submit list of staff members who participated in the training.
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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5