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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603424
Report Date: 05/30/2024
Date Signed: 05/30/2024 10:00:23 AM

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
05/24/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240524095549
FACILITY NAME:NEW HOPE HOME CAREFACILITY NUMBER:
198603424
ADMINISTRATOR:MANZANO, CARMENCITAFACILITY TYPE:
735
ADDRESS:2146 VIRGINIA AVE.TELEPHONE:
(909) 306-7757
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:4CENSUS: 3DATE:
05/30/2024
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Remy ColemanTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff did not ensure client attended scheduled medical appointments.
INVESTIGATION FINDINGS:
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Licesing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegation. LPA met with Remy Coleman and discussed the purpose of today's visit.

During this visit, LPA obtained a copy of the client and staff rosters, interviewed Staff #1 (S-1) and Staff #2 (S-2) and interviewed Client #1 (C-1). LPA reviewed C-1's file and obtained relevant documentation. LPA attempted to interview C-2 and was unable to obtain relevant information. LPA did not interview C-3 as C-3 was not present during this visit.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
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-20240524095549
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: NEW HOPE HOME CARE
FACILITY NUMBER: 198603424
VISIT DATE: 05/30/2024
NARRATIVE
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Allegation: Staff did not ensure client attended scheduled medical appointments. Staff and client interviews revealed that S-1 was late for C-1's dental appointment and as a result, C-1's dental appointment was cancelled. Per interviews, San Gabriel Pomona Regional Center was made aware of this situation and they were able to refer C-1 for a same day emergency dental appointment due to C-1's pain. Interviews conducted corroborate this allegation.

Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 1 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to Remy Coleman
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240524095549
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: NEW HOPE HOME CARE
FACILITY NUMBER: 198603424
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/05/2024
Section Cited
CCR
80072(a)(9)
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80072 (a)(9) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: To receive or reject medical care, or health-related services, except for minors and other clients for whom a guardian, conservator, or other
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Administrator to conduct a training on personal rights and include the importance of staff arriving to clients medical care (including dental) appointments in a timely manner. Administrator to submit a written statement in regards to this training along with sign-in sheet of attendess to LPA Irra.
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except for minors and other clients for whom a guardian, conservator, or other legal authority has been appointed. legal authority has been appointed. This standard is not met as evidence by: Interviews revealed that S-1 was late for C-1's dental appointment and as a result, C-1's dental appointment was cancelled
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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3