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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603251
Report Date: 12/17/2021
Date Signed: 12/17/2021 12:50:18 PM

Substantiated


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
07/31/2020 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200731112112
FACILITY NAME:VB CARE HOMESFACILITY NUMBER:
198603251
ADMINISTRATOR:BEVINAHALLI SURESHFACILITY TYPE:
735
ADDRESS:18412 DEL BONITATELEPHONE:
(714) 393-6361
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:6CENSUS: 6DATE:
12/17/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jared Mau (Direct Support Staff)TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff member inappropriately handled client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced visit to the facility for the purpose of delivering complaint findings. Upon arrival, LPA met with Jared Mau (Direct Support Staff) and explained the purpose of the visit.

On 08/07/20 an initial complaint investigation was conducted telephonically. LPA interviewed Staff #1 and requested a copy of the Staff/Client Roster.

On 12/10/21, LPA conducted a subsequent complaint investigation at the facility and obtained a copy of the Staff schedule and Client roster. Interviewed Staff #1 and Staff #2 in the dining area between 11:05 to 11:30 am. LPA attempted to interview client #1, however, client was not in the facility and is non-verbal. LPA attempted to contact client #1 placement agency to discuss the allegation, however, LPA was not successful.

Continue to LIC9099C....
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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-20200731112112
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: VB CARE HOMES
FACILITY NUMBER: 198603251
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/18/2021
Section Cited
CCR
80072(a)(3)
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Personal Rights
(a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of
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Licensee shall ensure that Staff #5 is no longer employed in the facility and provide additional training to Staff regarding Client's personal rights and provide proof to the department by the POC date.
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shelter, clothing, medication or aids to physical functioning. This requirement is not met as evidenced by: Video and photo indicated that Staff #5 was inappropriately handling Client #1 by slamming the door in Client #1's face and taunting and making of fun of Client #1. Video also indicate Client #1 crying while being taunted.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20200731112112
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: VB CARE HOMES
FACILITY NUMBER: 198603251
VISIT DATE: 12/17/2021
NARRATIVE
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In regards to the allegation: Staff member inappropriately handled client. Interviews with staff #3 and #4 revealed that staff #5 sent staff #3 a video and photos taken by staff #5, date of video and photo are not known. Staff # 3 & #4 watched the video and reviewed the photo. Staff #3 &#4 confirmed with LPA that the video shows staff #5 handling client #1 inappropriately by slamming the door in client #1's face and staff #5 taunting and making of fun of client #1, resulting in client #1 crying.

Based on LPA's interviews, investigation revealed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview conducted with Jared Mau (Direct Support Staff) and a copy of this report and appeals rights provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3