198602544-9-14-2023-28-AS-TVAO-CVSTEP-20230918144016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 09/14/2023
Date Signed: 09/14/2023 02:15:32 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
11/17/2022 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221117160637

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:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	George Aliimatafitafi - Houselead		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Clients did not receive prescribed medication
Staff did not dispensed medication as prescribed
Staff did not accurately document dispensed medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s)(LPA) Mary Flores conducted a subsequent unannounced complaint investigation regarding the above allegations. LPA Flores met with George Aliimatafitafi and explained the reason for the visit.

The investigation consisted of the following: On 11/22/22 LPA Flores conducted an initial complaint investigation visit in which LPA requested copies of the following documents staff/client roster. LPA conducted a medication review for clients #1-3(C1- C3), reviewed files, requested a copy of physician's report, medication sheets, and face sheets for C1-C3, reviewed files for staff #1-2(S1-S2) requested copies of staff Certification of Completion: New Hire Orientation - Medication Competency Test, and 35 hour training for Direct Support Staff for S1- S2. LPA interviewed S1, S2, and C2. On 8/21/23 LPA Flores conducted additional interviews over the phone. On 9/14/23 LPA Flores conducted interview with C3 and requested copies of staff's medication training dated 4/17/23 and medication sheets for clients for September 2023 and delivered findings for complaint. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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-20221117160637

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: 09/14/2023

NARRATIVE

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The investigation revealed the following: Regarding allegation: Clients did not receive prescribed medication, Staff did not dispensed medication as prescribed, and Staff did not accurately document dispensed medication. It is alleged staff have incorrectly dispensed, incorrectly documented client’s medication, and client did not receive evening dose as pill was stuck in the bubble pack. Interviews conducted with clients revealed 2 out of 3 clients stated to receive medication and 1 out of the 2 stated is being provided medication properly. 1 out of 3 clients was unable to be interview due to cognitive skills. Interviews with staff revealed 3 out of 3 staff stated to have received training on medication administration. Staff dispenses the medication per prescription, and note the medication given in clients' medication sheet. Administrator stated there were unknown medication issues prior to her taking the role of administrator as of November 2022. In addition, all staff have been currently train and no medication issues have been currently noticed. During the visit on 11/22/22 LPA reviewed medication and medication sheets for the 3 clients and did not observe medication errors on medication sheets. Medication sheets were initialed by staff for each day. One pill was observed missing on bubble pack for November cycle for 11/30/22 for client #2 (C2)'s medication. Per staff it had been popped by error, the pill was disposed and a refill was requested from the pharmacy. The pill was observed in a bottle dispenser with proper label. Documents reviewed revealed staff received a competency test on medication guidelines at the time of employment and last medication administration training was provided on 4/23/23.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Angela Williams - Administrator and a copy of this report will be email.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC9099 (FAS) - (06/04)

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