198603273-3-6-2023-28-AS-RORN-CQ5TXT-20230321150740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603273
Report Date: 03/06/2023
Date Signed: 03/06/2023 03:46:50 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
02/28/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230228134739

FACILITY NAME:	BRADBOURNE		FACILITY NUMBER:	198603273
ADMINISTRATOR:	PEREZ, JOEY		FACILITY TYPE:	735
ADDRESS:	1332 BRADBOURNE		TELEPHONE:	(855) 302-3331
CITY:	DUARTE	STATE: CA	ZIP CODE:	91010
CAPACITY:	4	CENSUS: 1	DATE:	03/06/2023
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Administrator - Joey Perez		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not providing meals for a client while in care.
Staff are not providing proper clothing items for a client.
Staff not treating client's with respect and dignity.
Staff forced a client to clean the shower.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced 10 day initial complaint visit at the above facility. Upon entry LPA met with Administrator Joey Perez to discuss the purpose of today's visit. Shortly after around 10am General Manager Ivett Busby met with LPA and Joey in regards to the purpose of the visit.

LPA Calderon collected and reviewed Client #1 (C1) FaceSheet, Behavior Intervention/ Progress Notes Plan, Indvidual Treatment Plan, Physican's Report, Task Schedule Chart, Staff (S1) resignation letter, Joey and S1's Education Training Sheet on Title 22, Client's Rights, Menu Planning, House Rules,and Abuse and Neglect and Staff #2 (S2) training on Residential Service Orientation. LPA collected the Food Menu for month of Feburary, Meeting Notes for C1's Meal Incidnet and C1's Feburay Behavior Data Sheet. Joey will email LPA Calderon: Special Incident Report regrding C1. LPA Interviewed Administrator Joey, General Manager Ivett, San Gabriel/ Pomona Regional Center (SGPRC) Quality Assurance Lisseth Duenas, Staff #1 (S1), attempt to interview Staff #2 (S2).
Continuation on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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-20230228134739

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: BRADBOURNE	FACILITY NUMBER: 198603273
	VISIT DATE: 03/06/2023

NARRATIVE

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LPA Calderon attempt to interview C1 not available, and Client #2 (C2) unsuccessful due to cognitive ability. LPA Calderon interviewed Client #3 (C3). LPA Calderon toured facility with Joey, LPA Calderon toured four (4) client's bedrooms, 2 bathroom, common areas, dining and kitchen area.

In regards to allegation: Staff are not providing meals for a client while in care. LPA Calderon observed and reviewed Food Menu posted on the refrigerator for staff, clients and visitor view. LPA Calderon observed lunch time and observed client present eating lunch. LPA observed two refrigerators located in the kitchen and the common space area, LPA Caldeon observed sufficient non- perishable and perishable food items for clients in care. LPA Calderon reviewed Joey's, S1 and S2 Menu Planning In-Service Log. LPA reviewed C1's Behavior Intervention/ Progress Notes Plan which states C1 has a Target Behavior Plan in regards to False Statement and False Allegations. Page 17, states C1 states false allegations in regards to staff denying him food. LPA interviewed staff Joey, Ivett, and S1 who denied the above allegation stating client's receive at least three meals a day. LPA Calderon interview C3 who stated food is served and there is sufficient food for all clients in care.

In regards to allegation: Staff are not providing proper clothing items for a client. LPA Calderon interviewed C1's Mother who stated parents manage C1's money. LPA Calderon interviewed staff Joey, Ivett and S1 all denied above allegation and stated clothing are in good condition. Ivett stated P&I is only managed for one client in care which is C2. LPA interview C3 and denied allegation saying he is good with clothes, no issues. LPA Calderon observed four client's bedrooms/ clothing items cabinets and closet, and observed sufficient clothing in good condition.

In regards to allegation: Staff not treating client's with respect and dignity. LPA Calderon interviewed Staff Joey, Ivett, and S1 all denied the above allegation stating staff are professional, all get along with staff and clients in care. LPA Interviewed C3 and denied the above allegation that staff respect resident and do not neglect client(s). Joey stated in service training's are conducted for Personal Right's and Client's Rights. LPA Calderon observed Joey and S1's training education Log on Topics: Client Rights, Title 22, House Rules, and Abuse and Neglect and S2's Residential Service Orientation.

Continuation on LIC 9099-C...

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20230228134739

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: BRADBOURNE	FACILITY NUMBER: 198603273
	VISIT DATE: 03/06/2023

NARRATIVE

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In regards to allegation: Staff forced a client to clean the shower. LPA Calderon interview staff Joey, Ivett,and S1 all denied the above allegation stated staff are responsible to clean the facility. Joey stated 3 out of 4 clients in care have Activities of Daily Living (ADL's) to comply by with assistant of staff. Client's have Task Schedule Charts implemented by the Behavior Consultant, facility and in accordance with SGPRC. LPA interviewed C3 who stated he is asked to clean but not forced. LPA Calderon observed staff cleaning the facility during LPA's visit. LPA reviewed C1's Task Schedule Chart, and C1's Behavior Intervention/ Progress Notes - Page 21 states C1's Adaptive Skills goals are for C1 states is to complete cleaning routine in individual's room and bathroom.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of this report was provided Administrator Joey Perez.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC9099 (FAS) - (06/04)

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