198603035-4-15-2025-28-AS-DSIS-DFYPP5-20250422112855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603035
Report Date: 04/15/2025
Date Signed: 04/15/2025 05:07:58 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
03/17/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250317100251

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:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	02:47 PM
MET WITH:	Rudy Cienfuegos – Lead RBT (Registered Behavior Technician)		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff do not distribute resident's medication as prescribed.
Staff do not assist resident with obtaining medical care.
Staff yell at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Rudy Cienfuegos – Lead RBT (Registered Behavior Technician) and explained the reason for the visit.

The investigation consisted of the following:
During Initial visit dated 3/25/25 LPA requested copies of client/staff rosters, toured facility, LPA obtained copies of Client #1's (C1) Emergency Visit and Medication Administration Records (MAR) for March 2025, interviews were conducted with 3 staff (S1-S3) and 4 clients (C1-C4).
During todays subsequent visit LPA interviewed 1 staff and reviewed C1's Medication and Medication Administration Record for March/April 2025 and obtained copies of C1's MAR's, C1's IPP (Individual Program Plan) and Behavioral Notes (ABC's) from dates 3/17/25 and 3/25/25. LPA delivered findings on the reported allegations. (Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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-20250317100251

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: 04/15/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff do not distribute resident's medication as prescribed.
It is alleged that on 3/16/2025 and 3/17/2025, staff did not distribute C1 their medication or vitamins and when asked for them staff stated that they were withholding because of C1s mood. LPA reviewed 3 clients medications (including C1’s) and MAR’s all medication to be given as prescribed and signed by staff, there were no notes or observations made of medication errors, all medication refusals were properly documented and accounted for in their proper package. LPA reviewed C1’s IPP and ABC’s in which it is documented that C1 has ongoing history of medication refusal and making false allegations. LPA interviewed 4 clients and 3 out of 4 clients denied the above allegation and stated that staff have given them their medication daily and as prescribed. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating all medications are given as prescribed to clients, although at times clients may refuse medication, multiple attempts will be made and if they still refuse staff document information and generate an incident report.

Allegation: Staff do not assist resident with obtaining medical care.
It is alleged that on 3/16/25 C1 was not feeling well and asked staff to call emergency/911 and staff refused to call or give C1 medical attention. LPA interviewed 3 clients and 2 out of 3 clients denied the above allegation (the 4^th client terminated interview after answering questions pertaining to the first allegation), clients stated that they are able to call for emergency services on their own either using their personal phone or facility landline, 3 clients confirmed they have called emergency services in the past, and 2 clients denied that staff refuse to assist with their medical care. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that when emergency services are needed 911 is called. Interview with S2 revealed that in the case of emergency 911 is called however, if they are suffering a mental crisis staff try to de-escalate situation and use their resources (therapist/crisis prevention team) to assist prior to calling 911, but if needed and unable to de-escalate 911 will be called. During file review LPA observed an emergency visit for C1 dated 3/17/25, where C1 was sent to hospital for medical care.

(Continued on LIC9099-C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250317100251

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: 04/15/2025

NARRATIVE

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Allegation: Staff yell at resident.
It is alleged that staff yelled at C1 in defense of another client when C1 yelled at client to get out of their private room. LPA interviewed 3 clients and 2 out of 3 clients denied the above allegation (the 4^th client terminated interview after answering questions pertaining to the first allegation), clients stated that they have not been yelled at by staff and have not seen staff yell at other clients. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation stating that they have never yelled at a client or heard another staff yell at a client, although clients do exhibit aggressive behaviors staff try to de-escalate and bring clients back to baseline in a calm manner. Interview with S1 revealed that staff at this facility have not had to be talked to or reprimanded in these types of allegations. LPA reviewed C1’s IPP reports in which it is documented that C1 has history of making false accusations and distributes aggression as a strategy to avoid tasks that seem challenging.

Based on statements and interviews conducted with staff/clients, and review of client files, there was not enough supportive evidence to concur with the reported allegations. 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, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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