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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602596
Report Date: 10/06/2022
Date Signed: 10/06/2022 02:29:41 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
09/27/2022 and conducted by Evaluator Alma Gonzalez
COMPLAINT CONTROL NUMBER: 28-AS-20220927135645
FACILITY NAME:JASWILL BROOKMILLFACILITY NUMBER:
198602596
ADMINISTRATOR:CRUZ, JASFERFACILITY TYPE:
735
ADDRESS:7822 BROOKMILL RDTELEPHONE:
(562) 381-0242
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:4CENSUS: 4DATE:
10/06/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jasfer CruzTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately restrained resident while in care.
Staff mismanaged resident’s medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Jasfer Cruz and explained the reason for the visit.

The investigation consisted of: On 9/27/22, LPA received a copy of Unusual Incident/ Injury Report (LIC 624) dated 9/22/22 and Report of Suspected Dependent Adult/ Elder Abuse (SOC341) dated 09/22/22 from LPA Baptiste. On 10/06/22, LPA conducted interviews with Administrator Jasfer Cruz, Staff 1 (S1) and Clients 1-4 (C1-4). LPA obtained copies of Staff and Client Rosters. LPA conducted a tour of facility which included observations of common areas, dining room, and random client rooms. LPA reviewed C1-4's files and collected copies of documents pertinent to the investigation. LPA additionally reviewed C1-2's Medication Administration Records (MAR) and collected copies for the months of April 2022, May 2022 and October 2022.

(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
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 4
Control Number 28-AS-20220927135645
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: JASWILL BROOKMILL
FACILITY NUMBER: 198602596
VISIT DATE: 10/06/2022
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
LPA also attempted to interview South Central Los Angeles Regional Center (SCLARC) staff, Service Coordinator (SC) LaQuita Howard and Quality Assurance (QA) Iqwo Ntuen by telephone. LPA also attempted to interview S2 but was not able to be interview staff as they did not answer the phone or return LPA call.

Investigation revealed the following: Regarding allegation, Staff inappropriately restrained resident while in care, it is alleged that a facility staff used a taser sound and handcuffs to scare C1 when they misbehave. Facility staff allegedly know that C1 is afraid of law enforcement and used the taser sound and handcuffs to scare C1. Facility staff allegedly handcuffed C1 for a minute to restrain them from misbehaving. It is additionally alleged that facility administrator and licensees were informed and did not take action.
Interviews conducted with Administrator Jasfer Cruz, and S1 revealed that facility have never inappropriately restrained any client with handcuffs or anything else. They also denied that any staff have used a taser sound to scare C1 or any other client. They stated that if any client is having a behavior staff appropriately redirect the client but never restrain them with handcuffs or anything else and also do not scare the clients with taser sounds or anything else. Administrator stated that he was made aware by a former staff (S3) that S2 was allegedly scaring C1 when the client was misbehaving with something that sounded like a taser and that S2 had also allegedly handcuffed C1 for approximately one minute when C1 was misbehaving. Administrator stated that he conducted interviews with staff and clients and C1 denied that S2 ever scared them or handcuffed them for a minute and that staff denied seeing S2 do that. Administrator stated that S2 and S3 had personal problems and were not getting along. Administrator also stated that he interviewed two clients (C1-2) and they denied that any staff including S2 have ever scared them with a taser sound and stated that they had not seen S2 with handcuffs. Administrator stated that C3-4 are non-verbal. Administrator stated that both S2-3 were terminated due to the alleged incidents and not reporting timely if the alleged incidents did in fact occur or if there were any suspicions regarding such behavior. Administrator stated that S3 made the reports to him 6 months after they allegedly occurred and admitted to him that they only made the report due to being upset with S2. S1 stated that staff are aware that C1 is fearful of paramedic sirens but only try to comfort the client if they become agitated when they hear sirens. Interviews conducted with C1-2 revealed that staff have not inappropriately restrained them or any other client. C1 denied that S2 ever used a taser sound to scare them and denied that S2 ever handcuffed them. C1 stated that they liked S2 and that S2 was nice. C1-2 stated that staff are nice and they did not have any concerns regarding the staff or the facility. C3-4 were not interviewed as they are non-verbal. C1-2 stated that they are satisfied with the services that they receive at the facility and stated that facility staff treat them with respect at all times. LPA conducted
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20220927135645
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: JASWILL BROOKMILL
FACILITY NUMBER: 198602596
VISIT DATE: 10/06/2022
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
that they receive at the facility and stated that facility staff treat them with respect at all times. LPA conducted a tour of facility which included observations of common areas, dining room, and random client rooms and did not observe anything of concern. Based on LPA observations, and statements gathered from interviews conducted with staff and clients there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff mismanaged resident’s medication, it is alleged that a facility staff administered cough syrup to C1 six to seven months ago to make C1 go to sleep. C1 was allegedly prescribed cough medication when they were coughing but no longer needed the medication when the staff was allegedly administering it. It is not clear how much of the cough medication was given to C1 but it was allegedly given to the client in a medicine cup. Administrator Jasper Cruz and S1 revealed that facility staff only give clients their prescribed medications as they are prescribed and stated that PRN medications are given to clients only as needed and then properly documented when any medications are given to the clients. Administrator and S1 denied that any staff have given C1 or any other client cough medication to make them go to sleep. S1 stated that C1 was prescribed cough medicine on 11/2021 when they were sick but the medication was only used during the time the client had the symptoms for which the medicine was prescribed for. Administrator stated that he conducted interviews with staff and C1-2 and C1 denied that S2 ever gave them cough medicine in a cup to make them go to sleep. Administrator stated that S2 and S3 had personal problems and were not getting along. Administrator stated that C3-4 are non-verbal. Administrator stated that both S2-3 were terminated due to the alleged incidents and not reporting timely if the alleged incidents did in fact occur or if there were any suspicions regarding such behavior by facility staff. Administrator stated that S3 made the reports to him 6 months after they allegedly occurred and admitted to him that they only made the report due to being upset with S2. Interviews conducted with C1-2 revealed that staff give them their medications on time and they do not have concerns regarding medication administration. C1 denied that S2 gave them cough medicine to put them to sleep. C1 stated that they liked S2 and that S2 was nice. C1-2 stated that staff are nice and they did not have any concerns regarding the staff or medication administration. C3-4 were not interviewed as they are non-verbal. C1-2 stated that they are satisfied with the services that they receive at the facility and stated that facility staff treat them with respect at all times. LPA reviewed C1-2's MARs for the months of April 2022, May 2022 and October 2022 and did not observe anything of concern. LPA did not observe that a PRN medication was given to C1 on the MARs that were reviewed. LPA observed that MARs were properly completed when
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20220927135645
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: JASWILL BROOKMILL
FACILITY NUMBER: 198602596
VISIT DATE: 10/06/2022
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
medications are administered to clients. LPA reviewed a prescription for cough medicine for C1 dated 11/24/21. LPA also observed that C1 still had remaining cough syrup that was properly stored, locked and was inaccessible to clients. Based on LPA observations, record review and statements gathered from interviews conducted with staff and clients there was not enough supportive evidence to concur with the reported allegation.

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

Exit interview held. A copy of the report was provided to House Manager Lina Tenorio.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4