198603035-10-15-2024-28-AS-RORN-DAKNMR-20241031103531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603035
Report Date: 10/15/2024
Date Signed: 10/15/2024 04:31:49 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
10/07/2024 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241007112655

FACILITY NAME:	PUENTE HOME		FACILITY NUMBER:	198603035
ADMINISTRATOR:	MELISSA VAZQUEZ		FACILITY TYPE:	737
ADDRESS:	1423 E PUENTE AVE		TELEPHONE:	(626) 331-6331
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	4	CENSUS: 4	DATE:	10/15/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Samanatha Reyes, Assistant Administrator		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff member physically abused resident in care.

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 Assistant Administrator, Samantha Reyes to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegation.

The investigation consisted of the following: LPA interviewed the Assistant Administrator, Staff #1 (S1) - Staff #8 (S8). LPA also interviewed Client #1 (C1) - Client #4 (C4). LPA interviewed Witrness #1 (W1). LPA obtained copies from Client #1 (C1) file such as Physician's Report, Face Sheet, IPP, IBSP (Individualized Behavioral Progress Report), Client Notes, Hospital Discharge Paperwork, Medication List, and Special Incident Reports.

The investigation revealed the following: in regards to the allegation "Staff member physically abused resident in care. ", it is alleged that C1 was hit by staff and made C1 cry. No other details were provided.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

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-20241007112655

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: PUENTE HOME	FACILITY NUMBER: 198603035
	VISIT DATE: 10/15/2024

NARRATIVE

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All staff and witness interviewed denied the allegation. Eight (8) out of eight (8) staff interviewed indicated that they have never hit the clients in care nor have they observed any other staff members hit any clients in care. Interview with W1 indicated that C1 and C2 has a history of fabrication and making false accusations. Per document obtained dated 09/16/2024, C1 and C2 have a history of making allegations. C3 indicated that they have never been hit by staff nor have they seen staff hit any of the other clients. LPA reviewed all documentation that all clients have a history of making allegations. When attempting to obtain specific details that C2 was physically abused. Two (2) of the four (4) clients interviewed indicated that they have been physically abused by staff. C2 interviewed indicated that they have been grabbed by staff in the past. However, 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, the clients interviewed could not provide specific details regarding when this alleged physical abuse occurred. In addition, there were no witnesses that observed these two alleged incidents. No paperwork observed in the files that showed the staff have been reprimanded for physical abuse.

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 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 with the Assistant Administrator, Samantha Reyes 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: 10/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024

LIC9099 (FAS) - (06/04)

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