198602931-4-22-2025-28-AS-DSIS-DGQPBJ-20250516111026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602931
Report Date: 04/22/2025
Date Signed: 04/22/2025 02:43:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/16/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250416132743

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:	04/22/2025
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Elisa Apo, DSP		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff physically assaulted resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced 10-day complaint visit at the facility and met with S1 to discuss the purpose for today's visit and assisted with the visit. The purpose of the visit is to investigate the above allegation.

The investigation consisted of the following: LPA interviewed the Staff #1 (S1). Over the phone, LPA interviewed Staff #2 (S2), Staff #3 (S3). Client #1 (C1), Client #2 (C2), Witness #1 (W1) to Witness #3 (W3). LPA attempted to interview Client #3 (C3) and Client #4 (C4) but both clients are non-verbal and declined to be interviewed. LPA attempted to interview Client #5 (C5) to Client #6 (C6) but clients were unavailable to be interviewed as they were not home and out in the community. LPA obtained copies from Client #1 (C1) file such as Face Sheet, IPP (Individual Program Plan), Client Notes, Behavioral Report, and Special Incident Reports. LPA also obtained the staff and client rosters. LPA reviewed staff files such as CPI certificate and on-going staff training.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

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-20250416132743

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JOSHUA TREE HOME	FACILITY NUMBER: 198602931
	VISIT DATE: 04/22/2025

NARRATIVE

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The investigation revealed the following: in regards to the allegation "Staff physically assaulted resident” it is alleged that C1 was eating breakfast when S1 told C1 multiple times that the van to take C1 to the adult day program was waiting outside. C1 got angry that S1 kept saying the van was waiting, so C1 hit S1, and then S1 hit C1 back with the mop S1 was holding which resulted in bruising on C1’s left rib cage area. Admin and S1 interviewed denied the allegation. Admin and S1 interviewed stated that C1 hit S1 multiple times and S1 was attempting to defend and block C1’s punches and used the mop to block the punches. Admin and S1 stated that C1 grabbed the mop and as S1 and C1 were grabbing the mop, S1 let go of the mop which resulted in end of the mop handle to hit C1’s body. Staff #2 (S2) and Staff #3 (S3) who also worked on the day of incident could not confirm nor deny the allegation since both stated that they did not witness the incident. S1 is currently suspended pending investigation. Staff interviewed indicated that they never physically abused any clients but they indicated that they placed CPI holds as required on the clients in the past. However, based on staff interviewed, Admin and staff claimed that proper CPI procedure was not conducted in this incident. Based on staff and client interview, first aid and ice was applied and no hospitalization was required. This will be addressed in a separate case management visit report. LPA Interview with W1 indicated that C1 has a history of violent behaviors. LPA reviewed all documentation that C1 has a history of physical aggression, verbal/aggression and emotional outbursts towards staff and clients. One (1) of the two (2) clients interviewed corroborated with the allegation but stated client hitting the staff. One (1) of the two (2) clients interviewed did not provide an answer that confirms nor deny the allegation. In addition, there were no witnesses that observed the alleged incident. No paperwork observed in the files that showed the staff have been reprimanded for physical abuse. Based on interviewing Witness #1 (W1) to Witness #3 (W3) all stated speaking with C1 and that C1 did state getting hit by the S1 with the mop but C1 also informed them that C1 hit S1. One (1) of the three (3) witnesses interviewed stated that the facility did not follow proper CPI procedures and that C1 does not like when redirected or given reminders. LPA reviewed staff training in file. Therefore, there was insufficient evidence to corroborate with the allegations.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held with the Staff #4 (S4) and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2025

LIC9099 (FAS) - (06/04)

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