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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603035
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:39:15 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
11/18/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221118160320
FACILITY NAME:PUENTE HOMEFACILITY NUMBER:
198603035
ADMINISTRATOR:YASHICA MORROWFACILITY TYPE:
737
ADDRESS:1423 E PUENTE AVETELEPHONE:
(909) 596-5360
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Yashica MorrowTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff do not wear masks.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Yashica Morrow/Administrator and discussed the purpose of today's visit. LPA Irra observed and went under the screening process prior to entering the facility and observed all staff wearing masks. LPA also conducted a tour of the facility and observed COVID-19 signage posted throughout the facility. Bathrooms had hand washing signs along with paper towels.

During the 11/22/2022 visit (conducted by LPA Flores), LPA Flores conducted a tour of the facility with Christala Prudholme Lead Staff. LPA observed a screening station and was screened prior entering the facility. LPA observed signs and posters in common areas and bathroom #1(B1) and #2(B2) as well as paper towels, soap provided. LPA observed three (3) staff wearing N95s mask at the time of the visit. LPA requested a copy of client and staff roster.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
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 5
Control Number 28-AS-20221118160320
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: PUENTE HOME
FACILITY NUMBER: 198603035
VISIT DATE: 02/02/2023
NARRATIVE
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Allegation: Staff do not wear masks. During today's visit, LPA Irra interviewed Yashica Morrow/Administrator. Per Facility Administrator, all staff are required to wear masks during their shift. Per Facility Administrator, there was an isolated incident which occurred on 11/18/2022 during a Zoom meeting. Per Facility Administrator, during this meeting, Staff #1 (S-1) and Staff #2 (S-2) were observed not wearing a mask. Per Facility Administrator, S-1 was called and asked for S-1 and S-2 to wear their masks. Per Facility Administrator there has not been additional incidents of staff not wearing there masks. Per interview, this allegation is corroborated.

Based on interview, the preponderance of evidence standard has been met; therefore, the allegation is substantiated.

Deficiency was observed and cited per California Code of Regulation Title 22 Division 6. Refer to LIC9099D.

Exit interview held, copy of report and Appeal Rights were provided to Yashica Morrow.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20221118160320
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: PUENTE HOME
FACILITY NUMBER: 198603035
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2023
Section Cited
CCR
85095.5(c)(1)(F)
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Infection Control Requirements (c) An Infection Control Plan shall be developed by the licensee
and shall be included in the Plan of Operation required by Section 85022. (1)The Infection Control Plan shall include all of the following: (F)Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidence by safe and
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Administrator will ensure that facility is following California Dept of Public Health and CCLD requirements. Administrator will provide a written statement stating that staff will be retrained, and will comply with CDSS requirements and regulations, and will maintain a safe and healthful environment for residents and staff.
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effective job performance. This standard is not as evidence by: Per Administrator, there was an isolated incident (11/18/2022) during a Zoom meeting in which S-1 and S-2 were observed not wearing a mask. Per Facility Administrator, S-1 was called and asked for S-1 and S-2 to wear their masks.
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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/18/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221118160320

FACILITY NAME:PUENTE HOMEFACILITY NUMBER:
198603035
ADMINISTRATOR:YASHICA MORROWFACILITY TYPE:
737
ADDRESS:1423 E PUENTE AVETELEPHONE:
(909) 596-5360
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
02/02/2023
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Yashica MorrowTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Staff are not following COVID-19 protocols.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Yashica Morrow/Administrator and discussed the purpose of today's visit. LPA Irra observed and went under the screening process prior to entering the facility and observed all staff wearing masks. LPA also conducted a tour of the facility and observed COVID-19 signage posted throughout the facility. Bathrooms had hand washing signs along with paper towels. During today's visit, LPA obtained a copy of COVID-19 employee screening tool for Staff #1 (S-1) and Staff #2 (S-2) for 11/16/2022 through 11/24/2022.

During the 11/22/2022 visit (conducted by LPA Flores), LPA Flores conducted a tour of the facility with Christala Prudholme Lead Staff. LPA observed a screening station and was screened prior entering the facility. LPA observed signs and posters in common areas and bathroom #1(B1) and #2(B2) as well as paper towels, soap provided. LPA observed three (3) staff wearing N95s mask at the time of the visit. LPA requested a copy of client and staff roster. Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20221118160320
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: PUENTE HOME
FACILITY NUMBER: 198603035
VISIT DATE: 02/02/2023
NARRATIVE
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Allegation: Staff are not following COVID-19 protocols. During today's visit, Facility Administrator was interviewed. Per Facility Administrator, all staff are required to screen themselves prior to beginning their shift by utilizing the employee screening tool. LPA obtained a copy of COVID-19 employee screening tool for Staff #1 (S-1) and Staff #2 (S-2) for 11/16/2022 through 11/24/2022. Interview and collected documents do not corroborate this allegation.

Although the allegation may have happened or is 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 held, copy of report and Appeal Rights were provided to Yashica Morrow.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5