198603289-10-3-2023-28-AS-RORN-CWBVGC-20231005162519

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603289
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:06:57 PM

Substantiated

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
09/27/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230927155622

FACILITY NAME:	KAISER BEHAVIORAL CENTER WEST COVINA		FACILITY NUMBER:	198603289
ADMINISTRATOR:	INIGUEZ, JOANNA		FACILITY TYPE:	775
ADDRESS:	1532 AMAR ROAD STE B		TELEPHONE:	(626) 945-0790
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91790
CAPACITY:	75	CENSUS: 42	DATE:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Robert Reyes		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff posted a video on social media without client's consent.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Lead Supervisor Robert Reyes and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Lead Supervisor Robert Reyes, Staff 1, Client 1 (C1), and also conducted a telephone interview with San Gabriel Pomona Regional Center Service Coordinator (SGPRC SC) Carol Quinonez. LPA did not interview S2 as they are no longer an employee of the facilty. LPA obtained copies of Staff and Client Rosters. LPA additionally viewed the video that was posted on social media and collected a copy of Unusual Incident/ Injury Report dated 09/29/23 and Report of Suspected Dependent Adult/ Elder Abuse (SOC341) dated 09/27/23.

(See LIC9099C for continuation)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230927155622

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: KAISER BEHAVIORAL CENTER WEST COVINA	FACILITY NUMBER: 198603289
	VISIT DATE: 10/03/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff posted a video on social media without client's consent, it is alleged that a facility staff posted a video on social media without the client's knowledge or consent. Interview conducted with Lead Supervisor Robert Reyes revealed that a facility staff did post a video of a client on social media. He stated that S1 randomly came across the video on social media and immediately reported what they saw to Program Manager Vanessa Mejia. S1 stated that when they came across the video on social media they immediately informed Program Manager Vanessa Mejia. Lead Supervisor Robert Reyes stated that when he and Program Manager Vanessa Mejia learned of the video they reported the incident to District Manager Lee Strolo and met with S2 on 09/27/23 and asked S2 to delete the video. He stated that S2 stated that they had deleted the video and that S2 was placed on administrative leave. Lead Supervisor stated that S2 did not appear regretful about the incident. Lead Supervisor Robert Reyes stated that then facility immediately sent in the appropriate incident reports to both San Gabriel/ Pomona Regional Center (SGPRC) as well as Community Care Licensing (CCLD). C1 stated that they were not aware that S2 made a video of them and stated that they did not give S2 permission to post them on social media.

Based on LPA review of records and interviews conducted with facility staff and facility client, 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 Chapter 3 are being cited on the attached LIC9099D.

Exit interview conducted with Lead Supervisor Robert Reyes. A copy of this report and Appeal Rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230927155622

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: KAISER BEHAVIORAL CENTER WEST COVINA	FACILITY NUMBER: 198603289
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/13/2023 Section Cited CCR 82072(a)(3)	1 2 3 4 5 6 7	Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment...other actions of a punitive nature...including but not limited to: interference with the daily living functions...	1 2 3 4 5 6 7	Facility is to ensure that Title 22 Section 82072 regulations are met at all times. Additionally, facility will conduct an in-service training with all staff regarding this regulation and submit a sign in sheet with all staff signatures to CCLD by POC Due Date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interviews conducted with facility staff, the facility did not comply with the section cited above due to a facility staff posting a video of a client on social media without the client's consent, which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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