198603448-4-2-2024-28-AS-RORN-D9TT2U-20241007142121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603448
Report Date: 04/02/2024
Date Signed: 04/02/2024 03:40:43 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
03/27/2024 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240327160329

FACILITY NAME:	PEOPLE'S CARE FELLOWSHIP		FACILITY NUMBER:	198603448
ADMINISTRATOR:	FLORES, DENISE		FACILITY TYPE:	735
ADDRESS:	15762 FELLOWSHIP STREET		TELEPHONE:	(909) 287-3557
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	4	CENSUS: 4	DATE:	04/02/2024
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Administrator Janet De Luna		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff are falsifying MAR documents.
Staff do not ensure that resident(s) are provided their medication(s) as necessary.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced initial complaint investigation visit for the allegation above. LPA met with staff Janet Trujillo and explained the purpose of the visit. Administrator Janet De Luna arrived shortly after.

On todays visit LPA conducted the following: Interviewed clients #1-#3 (C1-C3), interviewed Staff #1-#3 (S1-S3), reviewed and collected copies of the staff and client roster. LPA also reviewed the medications on file for C1-C3 and collected the Medication Administration Records (MAR) for C1 for the month of March 2024. The investigation revealed the following:

In regards to the allegation "Staff are falsifying MAR documents" it was alleged that S1 falsely signed off other staff signatures on C1's new MAR for the date of 3/19/24.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

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-20240327160329

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: PEOPLE'S CARE FELLOWSHIP	FACILITY NUMBER: 198603448
	VISIT DATE: 04/02/2024

NARRATIVE

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(3) of (3) Staff interviewed denied the allegation. (3) of (3) Staff interviewed denied the allegation. Interviews stated that facility does have the most current MAR for all clients in care. Staff interviewed denied that there are any false signatures on the MAR and it is accurate. An updated MAR was received by the facility for 1 page related to C1's medications and that was because it had originally been missing the RX number for C1's ear drop medication. Interviews stated that staff would sign over any signatures onto the updated MAR sheet and signatures would not be forged. LPA reviewed the MAR on file for all clients for the last 2 months. Based on interviews, observations and files reviewed, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff do not ensure that resident(s) are provided their medication(s) as necessary" it was alleged that C1 did not receive their medication as needed on 3/19/24. (3) of (3) Staff interviewed denied the allegation. (3) of (3) Clients interviewed could not corroborate the allegation. Allegation details provided stated that the facility did not provide C1 their ear drop medication on 3/19/24 for the morning dose. Interviews with staff stated that C1 could not have been provided the morning dosage of that medication as the medication was not dropped off by the pharmacy until the afternoon of that day. File review shows a delivery receipt of the medication for C1 being dropped off 1:39pm on 3/19/24. The medication would then be provided the following medication window which was around 5pm. File review shows C1 receiving the medication as prescribed after it arrived to the facility. Based on interviews, observations and files reviewed, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024

LIC9099 (FAS) - (06/04)

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