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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603227
Report Date: 11/02/2023
Date Signed: 11/02/2023 04:00:30 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
08/12/2022 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220812111659
FACILITY NAME:WATERS PLACEFACILITY NUMBER:
198603227
ADMINISTRATOR:WATERS, LUTHERFACILITY TYPE:
735
ADDRESS:2177 WHITE STTELEPHONE:
(626) 696-3910
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:3CENSUS: 3DATE:
11/02/2023
UNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Luther Waters - AdministratorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff member hit client while in care.
Facility makes client buy food with their own money.
Facility does not allow client to have visitors.
Facility staff threatened client.
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 Luther Waters (Administrator) and Jaron Pryor (Administrator), the reason for the visit was explained.

The investigation consisted of the following:
Initial visit was conducted by (LPA) Glenn Trueman on 8/18/2022. LPA conducted a tour of the facility's kitchen with S1 (Staff 1) and garage to observe freezer. Facility observed 3 Client Bedrooms and 1 Client Bathroom and backyard area. Interviews were conducted with S1 and S2, LPA received copies of staff and resident rosters and various documents were requested from Client C1's file.

LPA requested copies of staff/client roster, food menu and visitation policy. LPA obtained the following copies from C1's files: Client Face Sheet, ID and Information, Physician's Report, Social Security
(Continued on the 9099-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: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
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 3
Control Number 28-AS-20220812111659
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: WATERS PLACE
FACILITY NUMBER: 198603227
VISIT DATE: 11/02/2023
NARRATIVE
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Supplemental Income, Social Securtity Income Changes, Record of Clients Safeguard Cash Resources with dates from 02/2020 - 7/2023, Unusual Incident Reports, Quarterly Progress Evaluations with Behaviors Consultant from 8/29/23 and 8/07/22, Request for Intensive Staffing (assesment with Behavior Analyst & Behavior Consultant) dated 1/17/23 and 11/30/22, Examinination Summary with Psychiatrist dated 9/10/23 and 6/3/22 and Staying Healthy Assessment dated 9/6/23. LPA interviewed 4 staff (S1-S4) and 2 clients (C1 and C2) during todays visit.
The investigation revealed the following:
Allegation: Staff member hit client while in care.
It is alleged that S1 slapped C1's hand while sorting fruit. During interview with S1 they stated that this incident occurred while at day program, facility staff assists with clients at day program, S1 had redirected C1 as C1 was having disruptive behaviors, on the 2nd redirection S1 asked C1 to take a private phone call away from group for privacy and upon returning C1 began to accuse S1 of smacking them. S1 denied smacking R1 or any client. Interview with C1 they stated that they have never been hit by staff and staff treats them with respect. When LPA mentioned allegation in more detail C1 confirmed that on that day they were getting upset with staff and didn't like being told to take their phone call outside, C1 stated that they now recall S1 smacking them but S1 is no longer an employee and they do not have issues with any staff. Interviews with S1-S3 revealed that S1 has a tendency to fabricate stories and be manipulative, they also stated that they have never hit a client nor witnessed another staff hit a client. During interview with C2 they stated that facility staff have never hit them. Review of Quarterly Progress Evaluations with Behaviors Consultant, Request for Intensive Staffing (assessment with Behavior Analyst & Behavior Consultant), Examination Summary with Psychiatrist indicated that C1 has history of making false allegations of others harming them and fabrication where they verbalize untrue stories. Review of the Staying Healthy Assessment dated 9/6/23 C1 indicated that they have never been hit by a staff member within the last year.

Allegation: Facility makes client buy food with their own money.
It is alleged that staff makes C1 purchase food with their own personal and incidental money. Interviews with S1-S4 each stated that facility staff does not make clients purchase their own food as food is provided to clients. LPA observed food menu and toured kitchen pantry, refrigerator and freezer in garage, there was sufficient amount of food supply to meet the needs of clients in care. Interviews with staff also revealed that C1 at times does not like what is on the menu so they prepare their own meals or purchase their own outside meals/snacks but it is never forced on clients to do so. Interview with C2 client indicated that they don't purchase any outside meals and always eat at the facility.

(Continued on 9099-C)
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220812111659
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: WATERS PLACE
FACILITY NUMBER: 198603227
VISIT DATE: 11/02/2023
NARRATIVE
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Allegation: Facility does not allow client to have visitors.
It is alleged that facility does not allow them to have visitors. Interviews with staff 4 out of 4 staff stated that clients are allowed to have visitors, the only time facility did not allow visitors was during the Covid 19 pandemic, in which case visitation was limited to out door visits only. Interviews with C1 and C2, both stated they are allowed to have visitors if they wish. C1 stated that they didn't allow visitors a while ago but now they do, LPA asked C1 to elaborate and C1 stated that they think it was because of the Covid pandemic but they are allowed to have visitors now. Interview with S2 and S3 revealed that C1's sister used to visit but as of recently no longer visits or answers calls from C1 or the facility. Facility has a Visitation Policy that indicates clients are allowed visitors.

Allegation: Facility staff threatened client.
It is alleged that facility staff threaten to not give C1 their incidental money. During interviews with S2 and S3 it was revealed that C1 receives Social Security Income (SSI), however, when C1 obtains a job and thier personal income is more that what SSI gives then the funds discontinue from Social Security and the client then becomes self responsible for their money. Per interview with S2, C1 has periods of time that they go without paying rent as SSI stops payment to facility and C1 does not use their private checks to pay rent, S2 also indicated that SSI is does take months before they adjust their records to reflect what funds client currently has, therefore, C1 may go without incidental money when they are unemployed and to avoid issues S2 on behalf of the facility will cover that income for the client. Interview with C1, they stated that sometimes they do not get their incidental money as staff refuses to give it to them. C1 stated they are self responsible with thier own checks and cash them on thier own. Based on review of Social Security Income revealed that during periods of time of employment C1's the payment was lowered throughout different periods as their personal income increased. LPA reviewed C1's Record of Clients Safeguarded Cash Resources with no issues. Interview with C2, client stated that they get their money without any issues. Interviews with staff 3 out of 4 staff stated that they never withhold money from clients, have never threatened clients and have never seen/heard another staff threaten a client.

Based on statements and interviews conducted with staff and clients, review of client file and facility file records, 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 to Jaron Pryor.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3