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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603467
Report Date: 02/01/2024
Date Signed: 02/01/2024 04:58:37 PM

Substantiated


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
01/22/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240122140149
FACILITY NAME:PEOPLE'S CARE LOMITASFACILITY NUMBER:
198603467
ADMINISTRATOR:JILLIAN FLORESFACILITY TYPE:
738
ADDRESS:14055 LOMITAS AVENUETELEPHONE:
(626) 474-2500
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:4CENSUS: 3DATE:
02/01/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jillian FloresTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff sleeping while on duty.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegation. LPA meet with Jillian Flores who assist with the visit. The purpose of the visit was explained.

The investigation consisted of the following: Obtained copies of Staff & Clients Rosters, interviewed Staff 1 to Staff 6 (S1 to S6), Client 2 (C2) and Client 3 (C3), QA ( Quality Assurance) from San Gabriel / Pomona RC. LPA also obtained the copies of relevant documents. In addition, a tour of the facility was conducted. All closets and cabinets were checked. C1 was sleeping at the time of visit and was not interviewed.

Continued 9099C

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
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 4
Control Number 28-AS-20240122140149
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 LOMITAS
FACILITY NUMBER: 198603467
VISIT DATE: 02/01/2024
NARRATIVE
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The investigation revealed the following: Staff sleeping while on duty: It was alleged that staff sleeping during their work shift.
During interviews with the staff, three (3) out of (6) corroborated the allegation that 1 staff has slept at the facility while on duty. S1 explained that they saw the picture that S5 is sleeping on their shift. S5 admitted that they felt a sleep during the work shift. Interviewed S1 stated that CCA (Coaching and Corrective Action) issued to S5. S1 provided the LPA documentation showing the disciplinary actions were taken addressing the issue. Also, in service training were provided to all staff. (3) out of (6) staff stated that they didn't hear or were witnesses that staff is sleeping during their work hours. Interviewed C2 and C3 denied the allegation. They stated that staff are not sleeping during their shift. Interviewed QA stated that RC received the complaint that staff is sleeping during their shift. Investigation was conducted and allegation was substantiated.

Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22) cited on the attached 9099 D.

Exit interview conducted with Jillian Flores . A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20240122140149
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 LOMITAS
FACILITY NUMBER: 198603467
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/01/2024
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision. (a)The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
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 The disciplinary actions were taken addressing the issue. Also, in service training were provided to all staff.
Citation was cleared at the time of this visit. No further action is needed.


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Based on interviews and record review, LPA determined that S5 had slept during scheduled work shifts, which poses a potential health and safety risk.
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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: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4