198602571-2-11-2025-28-AS-RORN-DE3PTL-20250220103607

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602571
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:40:49 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
02/06/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250206141248

FACILITY NAME:	A AND M ARMOUR HOME CARE		FACILITY NUMBER:	198602571
ADMINISTRATOR:	SYLVIA OWENS		FACILITY TYPE:	735
ADDRESS:	2145 ARMOUR STREET		TELEPHONE:	(909) 618-7065
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	4	CENSUS: 4	DATE:	02/11/2025
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Administrator IFEOMA OSONWA		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff overmedicated a client while in care.
Staff allowed a client to be soiled while in care.
Staff did not provide laundry service to a client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 2/11/2025 regarding the above allegations. LPA was greeted by Direct Support Staff Javier Garcia and explained the purpose of the visit. Administrator Ifeoma Osonwa arrived shortly after.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 3 interviews (S1 - S3), Attempted interview of Client#1-3 (C1 - C3), Interview of Clients# 4-5 (C4 - C5), Attempted interview of C1’s responsible party, copies of Client#1 (C1): Admission Agreement, Individual Program Plan (IPP), Client Notes, Medication Administration Record (MAR) for the month of December 2024, Face sheet, and physical plant tour.

See 9099-C for continued report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

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-20250206141248

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: A AND M ARMOUR HOME CARE	FACILITY NUMBER: 198602571
	VISIT DATE: 02/11/2025

NARRATIVE

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The investigation revealed the following: Regarding Allegation(s)- Staff overmedicated a client while in care. It is alleged staff overmedicated C1 on 12/23/2024. C1 was admitted into the facility on 12/18/2024. During records reviewed, LPA Ramirez observed MAR for December 2024 for C1. LPA Ramirez did not observe any discrepancies on MAR. LPA Ramirez observed medication orders for C1 and did not observe discrepancies. Three (3) out of the three (3) staff interviewed denied this allegation. C1 is no longer at the facility and unavailable for interview. LPA Ramirez attempted to contact C1’s responsible party and was unavailable for interview. C2 - C3 are non-verbal and unavailable for interview. Two (2) out of the two (2) clients interviewed denied this 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.

Staff allowed a client to be soiled while in care. It is alleged staff allowed C1 to remain soiled on 12/23/2024. During records reviewed, LPA Ramirez observed C1’s physician report that indicates C1 requires assistance with toileting. LPA Ramirez observed facility client notes for C1 dated 12/18/2024 through 12/23/2024, that documented facility staff assisting C1 with toileting. On 12/23/2024 during the AM shift, staff notes documented C1 was assisted with toileting twice in the AM. Three (3) out of the three (3) staff interviewed denied this allegation. C1 is no longer at the facility and unavailable for interview. LPA Ramirez attempted to contact C1’s responsible party and was unavailable for interview. C2 - C3 are non-verbal and unavailable for interview. Two (2) out of the two (2) clients interviewed denied this 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.

Staff did not provide laundry service to a client. It is alleged staff refused to wash C1’s bedding on 12/23/2024. Three (3) out of the three (3) staff interviewed denied this allegation. C1 is no longer at the facility and unavailable for interview. LPA Ramirez attempted to contact C1’s responsible party and was unavailable for interview. During facility tour, LPA Ramirez inspected four (4) client bedrooms and observed required linen on beds. Client bedrooms were not observed to be malodorous. Clients were observed to be well groomed. LPA Ramirez observed extra linen in the facility hallway cabinet. LPA Ramirez observed facility washing machine and dryer to be operational. Two (2) out of the two (2) clients interviewed denied this 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.

No violation were cited during this investigation. Exit interview was conducted. A copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/11/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025

LIC9099 (FAS) - (06/04)

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