198602544-10-2-2023-28-AS-LHIS-CWHKUN-20231011081300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 10/02/2023
Date Signed: 10/02/2023 11:46:08 AM

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
09/26/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20230926151636

FACILITY NAME:	PEOPLE'S CARE FERRERO		FACILITY NUMBER:	198602544
ADMINISTRATOR:	ANGELA WILLIAMS		FACILITY TYPE:	735
ADDRESS:	431 FERRERO LN		TELEPHONE:	(323) 330-7545
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	4	CENSUS: 3	DATE:	10/02/2023
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	Administrator Angela Williams		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Facility staff hit resident.
Staff do not administer resident's medication as prescribed.

INVESTIGATION FINDINGS:

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On 10/02/23 at 8:36 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with the administrator Angela Williams and explained the reason for the visit.

During today’s visit LPA toured the facility with Administrator. LPA obtained resident roster, staff roster, C1’s Individual Program Plan (IPP) dated 4/14/2023, C1’s physicians orders dated 9/1/2023 and 10/1/2023, C1’s Medical Administration Record (MAR) dated 9/1/2023, Incident report from the day program dated 9/22/2023, Incident reports dated 9/22/2023 and 9/25/2023 from the facility. LPA also interviewed: The administrator and a total of three (3) staff who shall be referred to as S1 through S3. LPA interviewed a total of 1 client via pone who shall be referred to as: C1. Due to client #2 and client #3 diagnosis, LPA could not conduct interviews. LPA also interviewed Regional Center Case Manager for C1.

Report Continued on 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: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

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-20230926151636

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: 10/02/2023

NARRATIVE

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The investigation reveals the following: Regarding " Facility staff hit resident.”. It is alleged that staff hit C1 on the head. During the visit LPA interviewed the administrator. The administrator denied the allegation stating, C1 attempted to AWOL and ran into the gate. Per administrator C1 has a history of self-injurious behaviors and fabrication. 3 out of 3 staff stated they have witness C1’s self-injurious behaviors and fabrication. 1 out of 3 staff stated they witnessed the incident of C1 trying to elope and hitting their head on the pin box at the gate. 1 out of 3 clients stated they are ok, and no one hurt them. The clients case manager stated the situation is part of the client’s behaviors that they are working on improving. LPA reviewed documentation and observed client has a history of fabrication and self-injurious behaviors.

The investigation reveals the following: Regarding " Staff do not administer resident's medication as prescribed.”. It is alleged that C1’s drug screen was negative for Lorazepam. During the visit LPA interviewed the administrator. The Administrator denied the allegation stated C1 always takes their medication. The administrator further stated there are rare times C1 refuses to take their medication but has always come back and took their medications as prescribed. 3 out of 3 staff denied the allegation, stating that C1 do not have a problem taking medications. 1 out of 3 clients did not want to talk about their medications. The Case Manager stated C1 do not have any issues taking medications. LPA reviewed C1’s MAR and did not observe any discrepancy.

Based on LPA's 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 allegation is 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: 10/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023

LIC9099 (FAS) - (06/04)

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