198603436-12-8-2023-28-AS-RORN-CZYMJ3-20240130083828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603436
Report Date: 12/08/2023
Date Signed: 12/08/2023 10:52:10 AM

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
12/01/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231201113755

FACILITY NAME:	HIGHPOINTE CARE - FRENCH LANE		FACILITY NUMBER:	198603436
ADMINISTRATOR:	STEWART, REUBEN		FACILITY TYPE:	735
ADDRESS:	430 FRENCH LN.		TELEPHONE:	(562) 682-0946
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 2	DATE:	12/08/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Brandon Iwabuchi and Adegboyega Agbelusi		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Facility staff refused to give a client a meal before receiving medication.
Facility staff yelled at a client.
Facility staff threatened a client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial visit to investigate the above allegations. LPA met with Brandon Iwabuchi/S-1 and explained the purpose of today’s visit. Adegboyega Agbelusi arrived at approximately 8:50 A.M..

During this investigation, LPA obtained a copy of the staff roster, client roster, reviewed files for C-1 and C-2 and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #5 (S-5) and interviewed Client #1 (C-1) and Client #2 (C-2). LPA also left a message for San Gabriel Pomona Regional Center (Quality Assurance) for a return call.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

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-20231201113755

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: HIGHPOINTE CARE - FRENCH LANE	FACILITY NUMBER: 198603436
	VISIT DATE: 12/08/2023

NARRATIVE

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Allegation: Facility staff refused to give a client a meal before receiving medication. It has been alleged that on 12/01/23, a client requested to have breakfast before taking medication and staff refused to give the client breakfast. Staff interviews revealed that breakfast is offered every morning for all clients prior to taking medication. Staff interviews revealed that staff do not refuse to give clients their meals. Interviewed staff indicated that they have not received any complaints/concerns nor witnessed any staff refusing to provide clients meals (including prior to receiving medication). Interviewed staff indicated that C-1 has a history of fabricating stories (being monitored and recorded). (1) out of (2) interviewed clients indicated staff provide meals before receiving medication. Interviews do not corroborate this allegation.

Allegation: Facility staff yelled at a client. It has been alleged that staff yelled at a client. Staff interviews revealed that staff do not yell at clients. Interviewed staff indicated that they have not received any complaints/concerns nor witnessed any staff yelling at any clients. Interviewed staff indicated that they are trained in mandated reporting, zero tolerance and client rights. Interviewed staff indicated that C-1 has a history of fabricating stories (being monitored and recorded). (1) out of (2) interviewed clients indicated staff do not yell at clients. Interviews do not corroborate this allegation.

Allegation: Facility staff threatened a client. It has been alleged that staff threatened to hit a client with a broom. Staff interviews revealed that staff do not threaten clients (including threatening to hit clients with a broom). Interviewed staff indicated that they have not received any complaints/concerns nor witnessed any staff threatening clients (including threatening to hit clients with a broom). Interviewed staff indicated that they are trained in mandated reporting, zero tolerance and client rights. Interviewed staff indicated that C-1 has a history of fabricating stories (being monitored and recorded). (1) out of (2) interviewed clients indicated staff do not threaten clients (including threatening to hit clients with a broom). Interviews do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, 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.

An exit interview conducted, appeal rights and a copy of this report was provided to Adegboyega Agbelusi.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2023

LIC9099 (FAS) - (06/04)

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