198603003-12-5-2023-28-AS-RORN-CYFPCA-20231212101138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603003
Report Date: 12/05/2023
Date Signed: 12/05/2023 05:59:36 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
11/28/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231128083025

FACILITY NAME:	ALTA LOMA GARDENS RESIDENTIAL CARE #2		FACILITY NUMBER:	198603003
ADMINISTRATOR:	STARK PLEITEZ, ANA M		FACILITY TYPE:	740
ADDRESS:	1667 WOODBEND DR		TELEPHONE:	(818) 922-5427
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	6	CENSUS: 6	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ana Margarita Pleitez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff physically abused resident in care.
Staff speaks to resident in an inappropriate manner.
Staff left resident in wheelchair for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Ana Margarita Pleitez and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Ana Margarita Pleitez, Staff 1-2 (S1-2), and Residents 1-5 (R1-5). R6 was not in the facility at the time of visit. LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file and S1-2's staff files and collected copies of documents pertinent to the investigation. LPA additionally conducted a tour of facility inside and out including resident rooms, restrooms, living room, kitchen and dining area. LPA observed clients in care.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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-20231128083025

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: ALTA LOMA GARDENS RESIDENTIAL CARE #2	FACILITY NUMBER: 198603003
	VISIT DATE: 12/05/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff physically abused resident in care, it is alleged that a facility staff hit a resident on the hand and also kicked a resident's leg. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff did not physically abuse R1 or any other resident and have never hit any facility resident on their hands or kicked their legs. Facility staff all stated that all facility residents are treated with dignity and respect at all times. Staff stated that there is a zero-tolerance policy on abuse and will report any type of abuse if they observe any staff physically abusing a resident. LPA conducted interviews with 1 out of 6 residents who stated that they were hit on the hand and their leg was kicked by a staff that does not work in the facility anymore. 4 out of 6 residents stated that they have never been hit by staff and stated that they have not seen staff hit any other resident. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs. LPA reviewed staff files and observed that they receive annual training on abuse. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff speaks to resident in an inappropriate manner, it is alleged that facility staff call a resident names, body shame and make fun of resident's speech. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff have never called a resident names, body shamed or made fun of resident's speech. Facility staff all stated that all facility residents are treated with dignity and respect at all times. Staff also stated there is a zero-tolerance policy on any type of abuse and will report if they observe any staff verbally abusing a resident. LPA conducted interviews with 1 out of 6 residents who stated that a staff that does not work at the facility anymore called them names, body shamed them and also made fun of resident's speech. 4 out of 6 residents stated that they have never been called names, body shamed or made fun of by staff and stated that they have not seen or heard staff do that to any other resident. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs and did not observe or hear staff making inappropriate comments to any resident. LPA reviewed staff files and observed that they receive annual training on abuse. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231128083025

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: ALTA LOMA GARDENS RESIDENTIAL CARE #2	FACILITY NUMBER: 198603003
	VISIT DATE: 12/05/2023

NARRATIVE

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For allegation, Staff left resident in wheelchair for an extended period of time, it is alleged a facility staff neglected a facility resident by leaving them in their wheelchair for three hours. Interviews conducted with Administrator Ana Margarita Pleitez and S1-2 revealed that staff have never neglected a facility resident by leaving them in their wheelchair for three hours. Facility staff all stated that all facility residents are treated with dignity and respect at all times and they are constantly checking on residents to see if they need anything or need assistance. LPA conducted interviews with 1 out of 6 residents who stated that a staff that no longer works in the facility neglected them by leaving them in their wheelchair for three hours. 2 out of 6 residents stated that they have never been neglected and have never been left in their wheelchair for a long period of time. 2 out of 6 residents stated that they do not use a wheelchair and that staff tend to them in an appropriate amount of time and they have not been neglected by staff. 1 resident was not in the facility during LPA visit. LPA observed 5 out of 6 residents in the facility and did not observe anything of concern. LPA observed 1 resident in the living room watching television and 4 residents were in their rooms. LPA observed staff tending to residents needs and did not observe any resident left in a wheelchair for an extended period of time. Based on statements gathered from interviews conducted with staff, facility residents and LPA observations, 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 violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Facility Caregiver Bobbie Robertson.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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