198602931-12-22-2023-28-AS-DSIS-CZ7VZK-20240105155252

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602931
Report Date: 12/22/2023
Date Signed: 12/22/2023 10:23:05 AM

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
12/18/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231218094923

FACILITY NAME:	JOSHUA TREE HOME		FACILITY NUMBER:	198602931
ADMINISTRATOR:	JASMIN TOMINES		FACILITY TYPE:	735
ADDRESS:	18207 VILLA CLARA STREET		TELEPHONE:	(626) 295-2197
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY:	6	CENSUS: 6	DATE:	12/22/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Lisa Apo		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff did not prevent resident from being harmed by another resident

INVESTIGATION FINDINGS:

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On the above date, Licensing Program Analyst (LPA) Wong conducted an initial 10 days complaint visit
to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with DSP II Lisa Apo and explained the reason of the visit and assisted with the visit.

The investigation consisted of the following: LPA interviewed two clients (C2-C3), attempted to interview three clients (C4-C6), two staff (S1 and S2) in the facility. LPA also interviewed C1 and administrator via telephone. LPA also obtained documents included C1 and C2's face sheet, Individual Program Plan (IPP) and Behavioral report.

See LIC 9099C for continuation

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

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-20231218094923

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: JOSHUA TREE HOME	FACILITY NUMBER: 198602931
	VISIT DATE: 12/22/2023

NARRATIVE

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The allegation revealed of the following: Allegation "Staff did not prevent resident from being harmed by another resident" LPA interviewed clients and stated the facility staff did separate the clients while the clients were having some physical altercation few months ago. The staff blocked the client before client hit again. Both staff and clients indicated no one had any injuries or bruises or did not require any medical attention during the altercation. The facility responded the incident and took appropriate action. The administrator stated one of the clients does not like people (clients and staff) talk behind the back and would trigger client's behavior. The staff has been constantly reminded other clients in the facility not to do that and redirected client not to put hands on other clients. The client also sees the behavioral therapist regularly to work on the coping skills.

Based on the interviews conducted with staff and clients and documents reviewed, 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 allegation is UNSUBSTANTIATED.

Exit interview conducted. A copy of this report and Appeal Rights were provided to DSP II Lisa Apo.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023

LIC9099 (FAS) - (06/04)

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