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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602852
Report Date: 04/15/2025
Date Signed: 04/15/2025 04:13:54 PM

Substantiated


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
03/21/2025 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250321165637
FACILITY NAME:PEOPLE'S CARE ROSEMEADFACILITY NUMBER:
198602852
ADMINISTRATOR:KRISTINE PANAMENOFACILITY TYPE:
775
ADDRESS:1280 SAN GABRIEL BLVDTELEPHONE:
(626) 802-5889
CITY:ROSEMEADSTATE: CAZIP CODE:
91770
CAPACITY:60CENSUS: 30DATE:
04/15/2025
UNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Xenia Carreon, Program ManagerTIME COMPLETED:
04:18 PM
ALLEGATION(S):
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Staff restrained client
Staff yelled at client
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alberto Lopez and Sakinah Madyun made subsequent visit to deliver findings for the allegations listed above. LPA met with Program Manager, Xenia Carreon, and explained the reason for the visit.

The investigation consisted of the following:
On 03/27/2025, LPA Lopez conducted tour of facility, obtained staff and resident rosters. Interviews with eight (8) staff (S#1 – S# 8) obtained written statement from one (1) staff (S#9) and attempted to interviewed two (2) clients.
LPA Lopez interviewed total of ten (10) staff.
The investigation revealed regarding allegation: Staff restrained client. It is alleged that staff restrained client.

(continued on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
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 3
Control Number 28-AS-20250321165637
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 ROSEMEAD
FACILITY NUMBER: 198602852
VISIT DATE: 04/15/2025
NARRATIVE
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(Continued from 9099)

LPA interviewed ten (10) staff and seven (7) of ten (10) staff were able to corroborate the allegation. Two (2) clients interviewed were not able to answer questions. The incident occurred on 03/21/2025 at around 12:00 to 12:30PM. According to some staff statements, C1 was in distress and yelling loud. One (1) staff went to the nautical room to assist with C1 after one staff radioed for help. There were 3 staff present. Some staff stated that C1 will yell when C1 wishes to use the bathroom or wants to get up. One staff stated that they were instructed by manager to not let C1 walk around with out shoes for C1 safety. Several staff stated they witness S10 preventing C1 from getting up from chair. S10 stated that C1 was pushing S10 and other staff trying to get up. S10 denied restraining C1. S10 admitted that C1 was pushing S10 and other staff in attempt to get up and was not allowed by S10 and stated S10 was using CPI. LPA interviews revealed that S10 use S10 hands and arm as restraint to prevent C1 from getting up from chair. Seven (7) staff stated they witness S10 using restrain on C1. LPA asked several staff if S10 may have been using CPI and all seven staff stated that it was not CPI, that it was clearly a restraint that is prohibited. There is enough evidence to substantiate this allegation.

Allegation: Staff yelled at client. It is alleged that staff yelled at resident. LPA interviewed 10 staff and one (1) staff of ten (10) staff witness S10 yelling at C1. One staff stated that one (1) staff yelled at resident and said the following: “"STOP IT, SIT DOWN, YOU NEED TO CALM DOWN!” In aggressive and loud tone. There is sufficient evidence to substantiate this allegation.

Based on LPAs, interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 1), are being cited on the attached LIC 9099D.



An exit interview was conducted. A copy of this report, Plan of Correction, and appeal rights were discussed and provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250321165637
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 ROSEMEAD
FACILITY NUMBER: 198602852
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2025
Section Cited
CCR
82072(a)(1)
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82072 Personal Rights

(a) Each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons.

The requirement is not met as evidenced by:
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Licencee will conduct staff training on person rigths and send proof to LPA by POC date.

****POC provided during visit, no further action required****

C10 resigned on 3/28/2025 while on leave.
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LPA interviews revealed that S10 yelled at C1 in a loud and aggressive tone which posed immediate health and safety risk to persons in care.
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Type A
04/16/2025
Section Cited
CCR
82072(a)(3)
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82072 Personal Rights
(a) 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.

The requirement is not met as evidenced by:
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Licensee will conduct staff training on person rights and send proof to LPA by POC date.

****POC provided during visit, no further action required****

C10 resigned on 3/28/2025 while on leave.
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LPA interviews revealed that S10 use S10 hands and arm as restraint to prevent C1 from getting up from chair which posed a immediate health and safety risk for persons in care.
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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: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3