198603467-2-11-2023-28-AS-RORN-D2GUL7-20240215144015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603467
Report Date: 02/11/2023
Date Signed: 02/11/2023 04:45:26 PM

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
02/07/2022 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20220207161842

FACILITY NAME:	PEOPLE'S CARE LOMITAS		FACILITY NUMBER:	198603467
ADMINISTRATOR:	POUESI, AGAIOTUPU		FACILITY TYPE:	738
ADDRESS:	14055 LOMITAS AVENUE		TELEPHONE:	(909) 287-3557
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91746
CAPACITY:	4	CENSUS: 4	DATE:	02/11/2023
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jillian Flores, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff administered medication to resident(s) not prescribed by a physician.
Staff engaged in inappropriate physical contact with resident(s).
Resident(s) not accorded dignity in relationships with staff.
Staff did not provide quality meals to meet the needs of resident(s).
Resident(s) not free from humiliation, intimidation, ridicule, threat, mental abuse, or other actions of a punitive nature.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint investigation for the allegations listed above. LPA met with the Administrator, Jillian Flores and explained the reason for the visit.

During the initial visits conducted by LPA David Sicairos on 2/15/2022 and LPA Bennette Pena on 1/20/2023, LPAs obtained copies of Staff and Client Rosters, complaint investigation letter from San Gabriel/Pomona Regional Center, Weekly Food menu, In-service training Record (Feb. 2022), Individual Behavioral Support Plan (IBSP), TheraP (Sep. & Dec. 2022, and Jan-Feb 2023), and Medication Administration Records (MARs) for C2 (Dec. 2022 & Jan. 2023) and Client #1 (C1) and Client #2 (C2) files. LPAs also inspected the food supplies, interviewed Staff #1-Staff #3 (S1-S3) and attempted to interview Client #1 (C1) but did not want to speak with LPA.

During today's visit, LPA Pena interviewed Client #3-Client #5 (C3-C5), telephonically inerviewed Client #2 (C2) and Staff #4 (S4), attempted to interview Client #1 (C1) but unsuccessful because he is non-verbal and re-inspected food supplies.
******CONTINUED LON LIC 9099C*******

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2023

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-20220207161842

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: PEOPLE'S CARE LOMITAS	FACILITY NUMBER: 198603467
	VISIT DATE: 02/11/2023

NARRATIVE

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Staff administered medication to resident(s) not prescribed by a physician.

The investigation revealed the following: in regards to the allegation "Staff administered medication to resident(s) not prescribed by a physician.", it is alleged that facility staff gives medication to a resident that is not prescribed by a doctor. The complaint did not provide the name of the staff member(s) administering medications not prescribed by a physician. LPA reviewed C1’s medications and observed medications to be documented properly and given as prescribed. Interviews conducted with staff members, including S1 revealed that medications are administered as per doctors’ orders. Staff members indicated that they use a tool Therap to document clients' activities, behaviors, daily notes, reminders etc. electronically for each client. Staff members also use Medication Administration Record (MAR) form to document the clients daily intake of prescription medication and over the counter (PRN) medicines. MARs record medications to be administered by schedule and correctly per doctors’ orders during each Staff member's shift . Interviews conducted with clients revealed that they are provided with their medications on schedule and as prescribed. Clients interviewed stated they have not been given any medications that were not prescribed by their doctors. Therefore, there was insufficient evidence to corroborate with this allegation.

Staff engaged in inappropriate physical contact with resident(s).

The investigation revealed the following: in regards to the allegation “Staff engaged in inappropriate physical contact with resident(s)”, interviews with staff members revealed that C1 has a behavior of putting his head on staff’s shoulder when watching tv or when staff is using iPAD so he can see better, but staff redirect him immediately. Staff interviews revealed that they did not witness or have seen any staff member engaged in inappropriate physical contact or interaction with C1. Interviews conducted with clients revealed that they have not witnessed any staff member having physical contact with them or other clients. Therefore, there was insufficient evidence to corroborate with this allegation.

Resident(s) not accorded dignity in relationships with staff.

The investigation revealed the following: in regards to the allegation " Resident(s) not accorded dignity in relationships with staff “, it is alleged that two (2) clients (C1-C2) were restricted from participating the Christmas party on-site. Staff members denied the allegation and stated that all the clients in the facility were invited to the party. However, staff members indicated that some clients opted to stay in their rooms after a while because they felt uncomfortable when around a big group of people. Staff members stated that all the clients participated at the party and no one was excluded. Interviews conducted with clients revealed that everyone was invited, and all the clients in the facility ate and joined the party. There is no evidence that would conclude that the clients are not accorded dignity in relationships with staff. Therefore, based on interviews conducted and documents gathered, LPA has determined that this allegation is deemed to be unsubstantiated at this time.

******CONTINUED ON LIC9099C******

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220207161842

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: PEOPLE'S CARE LOMITAS	FACILITY NUMBER: 198603467
	VISIT DATE: 02/11/2023

NARRATIVE

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Staff did not provide quality meals to meet the needs of resident(s).

The investigation revealed the following: in regards to the allegation "Staff did not provide quality meals to meet the needs of resident(s)”, it is alleged that staff buy the bare minimum food for the residents but it is "not enough for a good quality of life". LPA toured the kitchen and observed the food supplies. Food items in the facility, both perishables and non-perishables were of good quality brands and supplies are adequate. Interviews conducted with staff members revealed that they follow the nutritionist recommendations and menu. Staff members always ask the clients what food they like and try to accommodate their requests when buying groceries. Staff also indicated that although part of the food budget is allotted for the staff, they also share these with the clients. Interviews conducted with clients revealed that they have not been served unhealthy food and they are being given priority on food choices and they are all satisfied. Therefore, there was insufficient evidence to corroborate with this allegation.

Resident(s) not free from humiliation, intimidation, ridicule, threat, mental abuse, or other actions of a punitive nature.

The investigation revealed the following: in regards to the allegation “Resident(s) not free from humiliation, intimidation, ridicule, threat, mental abuse, or other actions of a punitive nature”. Staff members interviewed denied the allegation. Based on interviews conducted with staff members, they stated that C2 voluntarily packed her stuff and stepped out of the facility to get attention but none of the staff members acted inappropriately towards her. Staff members stated that C2 has a behavior of fabricating stories to get her way, and then recanting it. S1 indicated that the Regional Center had investigated a similar allegation and had found it to be unsubstantiated. Interviews conducted with clients stated that staff members treated them well and they did not experience any staff members acted indifferently or disrespectful towards them. Clients interviewed indicated that they did not observe any staff members humiliate, intimidate, ridicule or punish any of them including C2.

Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview, a copy of this report and Appeals Rights were provided to the Facility Administrator, Jillian Flores.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2023

LIC9099 (FAS) - (06/04)

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