<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602544
Report Date: 03/15/2024
Date Signed: 03/15/2024 03:52:55 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
07/08/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220708115802
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:
03/15/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:George AliimatafitafiTIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are overmedicating resident
Resident sustained unexplained injury while in care
Staff hit resident
Staff are using inappropriate forms of punishment for residents
Staff denied furniture in resident's room
Staff denied resident's personal belongings in his room
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angelica Rea conducted another visit regarding the above allegations.
LPA was greeted by Lead staff, George Aliimatafitafi who assisted with the visit. Administrator, Angela Williams was unable to come to the facility on today's visit.

Regarding the allegation that : Staff are overmedicating resident. The investigation consisted of review of resident #1- resident #3's medication and medication administration record(s), interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3. Resident #1 was not interviewed due to resident #1's functioning level. The investigation revealed the following. It was alleged that staff was overmedicating resident #1. Staff interviewed were unable to corroborate the allegation. Six out of six staff interviewed stated that they have not observed staff overmedicating any of the residents. They stated that medication is administered as prescribed. LPA's review of resident medication, and medication administration records, shows that medication appears to be administered as prescribed. Residents interviewed were unable to corroborate the allegation.

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 6
Control Number 28-AS-20220708115802
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: 03/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that : Resident #1 sustained unexplained injury while in care. The investigation consisted of review of special incident report dated 6/24/22, review of Resident #1's Individual Program Plan, interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3. Resident #1 was not interviewed due to resident #1's functioning level. The investigation revealed the following: Staff interviewed stated that they have not observed that any residents have sustained unexplained injuries while in care. Staff interviewed stated that resident #1 has a history of self injuries behaviors. Six out of six staff interviewed stated that they have not observed residents with unexplained injuries. Review of special incident report dated 6/24/22, revealed that on 6/23/22, resident #1 had a self injurious behavior that left a small scratch next to his right eye. Residents interviewed were unable to corroborate the allegation.

Regarding the allegation that : Staff hit resident. The investigation consisted of interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3, and review of resident #2's Individual Program Plan (IPP). The investigation revealed the following : It was alleged that resident #2 stated that staff hit him. Staff interviewed were unable to corroborate the allegation. SIx out of six staff interviewed stated that they have not observed any staff hit any of the residents. Residents interviewed were unable to corroborate the allegation. Review of resident #2's IPP, indicates that resident #2 has a documented history of Self injurious behavior, and a history of making false allegations.

Regarding the allegation that : Staff are using inappropriate forms of punishment for residents. The investigation consisted of interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3. Staff interviewed were unable to corroborate the allegation. Six out of six staff interviewed stated that they have not observed staff using inappropriate forms of punishment for residents. Residents interviewed were unable to corroborate the allegation.

Regarding the allegation that : Staff denied furniture in resident's room. The investigation consisted of interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3, and tour of facility. Staff interviewed were unable to corroborate the allegation. Six out of six staff interviewed, stated that residents are not denied furniture in their room. Resident interviewed were unable to corroborate the allegation. LPA observed on initial visit, and today's visit that residents have furniture in their room(s).
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20220708115802
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: 03/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that : Staff denied resident's personal belongings in his room. The investigation consisted of interviews with Staff #1 - Staff #6, and Resident #2 - Resident #3, and tour of facility. Staff interviewed were unable to corroborate the allegation. Six out of six staff interviewed, stated that residents are not denied having their personal belongings in their room(s). Residents interviewed were unable to corroborate the allegation. LPA observed on initial visit, and today's visit that residents have furniture in their room(s).


Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
07/08/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220708115802

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:
03/15/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:George AliimatafitafiTIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for residents
Resident had access to hazardous items
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Angelica Rea conducted another visit regarding the above allegations.
LPA was greeted by Lead staff, George Aliimatafitafi who assisted with the visit. Administrator, Angela Williams was unable to come to the facility on today's visit.

Regarding the allegation that : Staff did not seek medical attention for residents. It is alleged that staff did not seek medical attention for former resident #4. LPA Rea reviewed department records and observed that on 7/1/22 resident #4 had a behavior and staff performed two Crisis Prevention Intervention (CPI) on resident #4. Afterwards, Resident #4 stated to staff that his hand was hurting. However, staff did not seek medical attention for resident #4 until 7/4/22. During hospitalizaition, it was discovered that resident #4 had a fracture in his right hand.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 6
Control Number 28-AS-20220708115802
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: 03/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation that : Resident had access to hazardous items. It is alleged that former resident #4 was able to obtain 17 screws which were 2 1/2 inches long from his bedroom at the facility. Resident #4 took the screws and ingested them while on a home visit on 7/4/22. LPA Rea reviewed department records and observed that Staff #1 admitted that resident #4 took the screws from his dresser while under the care and supervision of the facility.

Based on interviews, observation, and document review conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Tittle 22, Division 6 and Chapter 1 are being cited.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20220708115802
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: 03/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/18/2024
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
(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.
1
2
3
4
5
6
7
Licensee and Administrator will ensure that residents personal rights are not violated. License and Administrator will ensure that all staff are properly trained on residents personal rights and will send proof of staff in service training to LPA by POC due date.
8
9
10
11
12
13
14
This requirement was not being met as evidenced by : upon review of department records, LPA Rea observed that Resident #4 complained of pain to his right hand for 3 days before the facility sought medical attention for resident #4. This poses and immediate health, safety, and/or personal rights risk to the clients in care.
8
9
10
11
12
13
14
Type A
03/18/2024
Section Cited
CCR
87993
1
2
3
4
5
6
7
(a) In addition to Section 80078, the following shall apply: (1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs.
1
2
3
4
5
6
7
Licensee and Administrator will ensure that resident(s) need and services plan is adhered to, to ensure that resident(s) needs are being met. Licensee/Administrator will send proof of staff in service training on responsiblilty for providing care and supervision to LPA by POC due date.
8
9
10
11
12
13
14
This requirement was not being met as evidenced by : upon review of department records, LPA Rea observed that Resident #4 was able to access 17 screws that were 2 1/2 inches long, which he later ingested.

This poses an immediate health, safety, and/or personal rights risk to the clients in care.
8
9
10
11
12
13
14
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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6