198603045-11-14-2022-28-AS-FFIS-CN9PJ3-20230120102050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603045
Report Date: 11/14/2022
Date Signed: 11/14/2022 12:55:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/15/2021 and conducted by Evaluator Ashley Calderon

COMPLAINT CONTROL NUMBER: 28-AS-20210315140126

FACILITY NAME:	WHITE ROSE GUEST HOME		FACILITY NUMBER:	198603045
ADMINISTRATOR:	SHINDY, TAMMY		FACILITY TYPE:	735
ADDRESS:	19161 ALDORA DR		TELEPHONE:	(626) 581-8358
CITY:	ROWLAND HEIGHTS	STATE: CA	ZIP CODE:	91748
CAPACITY:	4	CENSUS: 4	DATE:	11/14/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Francine Compana- House Lead		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner.
Facility staff are not safeguard residents belongings .

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon and LPA Kimberly Ramirez conducted an unannounced subsequent complaint visit to gather information and deliver findings regarding the above allegations. LPA Calderon was greeted by House Lead Francine Compana and discussed the purpose of today's visit .

On 3/23/21, LPA Kruz , interviewed Staff #1, #2 and Client #1 telephonically, requested a copy of the Staff/Client Roster and Client #1's records: Individual Program Plan -Progress Report, Client Development Evaluation Report, and Medical Evaluation

On 11/ 14/ 22, LPA Calderon and Ramirez visit consisted of requesting and receiving copies of documents such as : staff roster, cleints roster, staff personal rights training, and Client #1-4 Personal Belonging Inventory. LPA Calderon and Ramirez toured Clients 1-4 bedrooms and toured common areas of the home.
Continuation 9099C ...

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2022

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-20210315140126

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: WHITE ROSE GUEST HOME	FACILITY NUMBER: 198603045
	VISIT DATE: 11/14/2022

NARRATIVE

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The investigation revealed the following in regards to the allegation : Facility staff did not safeguard resident's belonging. LPA Calderon interviewed 3 out of 4 clients who were present at the facility. Client #3 and #4 denied having knowledge of staff failing to safeguard residents personal belongings and that each resident keeps their stuff in their rooms. No issues in regards to stealing belongings of clients. LPA Calderon attempt to interview client #2 was unable to communicate due to cognitive abilities. LPA Calderon interviewed client #1 on 11/14/21 and 12/30/22 in regards to safeguarding belonging. Client #1 had a concern about a bracelet belonging to self not being safeguarded. LPA received different answers from client #1 , client was not able to provide information about belonging. LPA Calderon reviewed client # 1 Individual Program Plan (IPP) states client behaviors are stating false allegations and stealing items that don't belong to self. LPA Calderon and LPA Ramirez was provided documentation of personal belonging inventory for client's #1-4. LPA's reviewed inventory of client #1 and inventory list does not show client having a bracelet as a personal belonging. LPA Calderon interviewed Staff #1 -4, all denied above allegation and stated they respect clients personal rights and their belongings. Staff stated clients belongings are in their rooms and inventory of personal belongings are done. All staff denied stealing from clients or have seen other staff steal from clients, keeping clients belongings safe. House Lead stated client #1 did not bring subject in regards to a bracelet belonging to client to staff attention and states no incidents in regards to bracelet of safeguarding this or any other belonging.

In regards to the investigation revealed the following in regards to the allegation : Facility staff handled resident in a rough manner. Client #3 and #4 denied facility staff handling clients in a rough manner , has not been pushed and their personal rights are respected. Client # 2 attempt interview cognitively unable to communicate. Client #1 was interviewed on 11/14/21 and 12/30/22 client #1 had different answers responses to staff handling client in rough manner, client #1 could not provide information when asked to identify a staff who handles client's in rough manner. LPA Calderon and Ramirez reviewed documentation for client #1 Behavior Services Report and client #1 Individual Program Plan showing client states false allegations. Staff #1-4 all denied the allegation of staff handling residents in a rough manner , never pushed or seen staff push / abuse clients. Staff #2 stated in regards to physical abuse we respect each client, their belongings and needs, we respect boundaries and their rights. S3 stated clients have their own opinions, choices, and aren't forced to do anything they don't want too.

LPA Calderon and Ramirez collected and reviewed staff training on Zero Tolerance Policy Training Regarding Abuse and Neglect. The training summary report stated " staff should not tolerate abuse and abuse shall be reported to proper authorities, and failure to report shall not be tolerated. In addition to assure the health and safety and security of the clients." Training is done yearly by San Gabriel/ Pomona Regional Center.

Based on interviews conducted from staff and client's and documents obtained, there was not sufficient information to support the allegations above. Although the allegations may have happened or is valid, there is not a preponderance of evidence the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

No citations noted at this time. Exit interview was conducted with Francine Compana and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2023

LIC9099 (FAS) - (06/04)

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