198603141-8-31-2023-28-AS-TVAO-CVDSFK-20230905135028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603141
Report Date: 08/31/2023
Date Signed: 08/31/2023 09:42:35 AM

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
07/12/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220712152203

FACILITY NAME:	RISING HILL DEVELOPMENTAL HOME		FACILITY NUMBER:	198603141
ADMINISTRATOR:	LEWIS, FELISHA		FACILITY TYPE:	735
ADDRESS:	1 RISING HILL RD		TELEPHONE:	(909) 417-5505
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	4	CENSUS: 3	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jennifer Oglesby		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Allegation: Personal Rights/Staff assaulted client resulting in injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit for the above allegation. LPA met with XXXX and discussed the purpose of today’s visit.

On 07/13/22, Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial 10-day complaint visit. LPA met with S-1 and explained the purpose of this visit. During this visit, LPA conducted a tour of this facility. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA also reviewed files for C-1 and S-2 and obtained relevant documentation. This investigation was also assigned to the Investigation Branch (IB) Investigator, Peter Zertuche.

Refer to LIC 9099C for the contination 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: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20220712152203

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: RISING HILL DEVELOPMENTAL HOME	FACILITY NUMBER: 198603141
	VISIT DATE: 08/31/2023

NARRATIVE

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Allegation: Personal Rights/Staff assaulted client resulting in injuries. This investigation was assigned to Investigation’s Branch (IB) Investigator, Peter Zertuche. IB Investigator Zertuche conducted interviews with the Alleged Victim (C-1), Facility Licensee, Facility Administrator, Staff #1 (S-1), San Gabriel Pomona Regional Center-Service Coordinator, San Gabriel Pomona Regional Center-Quality Assurance Investigator, Clients and interviewed a Detective from Pomona Police Department. IB Investigator also reviewed records for C-1 (including medical records and the police report from the Pomona Police Department).

The investigation revealed the following: On 07/11/22, there was an incident involving C-1 and S-1. S-1 was interviewed by police and reported S-1 was attacked by C-1 who was upset because C-1 missed the bus. C-1 grabbed S-1 by the shirt and pushed S-1 in to the window causing it to break. C-1 then got on top of S-1 and held S-1 down. S-1 tried to protect S-1 and attempted to get C-1 off S-1. S-1 recalled scratching C-1’s face while trying to get C-1 off S-1. S-1 also grabbed C-1 testicles and bit C-1 on the arm to try and get C-1 off S-1. At some point, S-1 was able to get away then walked outside and contacted the facility owner. S-1 reported no previous issues in the past. There were no other clients nor staff present at the this of this incident. At this time, it appears that S-1 acted appropriately after being physically attacked by C-1. The injuries sustained appear to be consistent with self-defense, S-1’s account, and the C-1’s brief statement regarding the altercation.

Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and a copy of this report and appeal rights were provided to Jennifer Oglesby.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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