198603474-8-3-2023-28-AS-TVAO-CV8SWH-20230831141419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603474
Report Date: 08/03/2023
Date Signed: 08/03/2023 10:53:42 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
07/28/2023 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230728144437

FACILITY NAME:	HELIO		FACILITY NUMBER:	198603474
ADMINISTRATOR:	MARCELO, TAJ		FACILITY TYPE:	735
ADDRESS:	510 FOXPARK DRIVE		TELEPHONE:	(929) 429-0836
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 4	DATE:	08/03/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Aura Alarcio/S-1.		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff are not properly trained to provide care to clients.
Staff are over medicating clients.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial investigation. LPA met with Aura Alarcio/S-1 and discussed the purpose of today’s visit. LPA spoke to Taj Marcelo (Administrator) via telephone and informed her the purpose of today's visit.

During this investigation, LPA obtained copies of the client and staff rosters, reviewed file for Client #3 (C-3) and obtained relevant documentation. LPA interviewed Staff #1 through Staff #4 (S-1 through S-4). LPA obtained relevant staff training records for S-2 and S-3 as both were present at the time of incident (07/26/23-night). LPA also reviewed medications for Client #1 through Client #4 (C-1 through C-4) and obtained copies of the Medication Administration Records (MARs).

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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-20230728144437

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: HELIO	FACILITY NUMBER: 198603474
	VISIT DATE: 08/03/2023

NARRATIVE

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Allegation: Facility staff are not properly trained to provide care to clients. Staff interviews revealed that staff are properly trained to provide care to clients. Per staff interviews, staff are trained in Behavioral Plans (including analyzing behavioral antecedents and data collection), Individual Program Plans (IPPs), Individual Service Plans (ISPs), Medication Administration and are trained in Crisis Prevention Intervention (CPI). Per staff interviews, on 07/26/23 (night), C-3 was exhibiting physical aggression towards staff, self-injurious behaviors and property destruction. Per staff interviews, staff attempted to re-direct and de-escalate C-3, however, C-3 continued to exhibit these behaviors and due to this, staff contacted the local police department for assistance/assessment. C-3 was taken to the local hospital for assessment. Interviews conducted and reviewed documentation do not corroborate this allegation.

Allegation: Staff are over medicating clients. Staff interviews revealed that staff are not over medicating clients. Per staff interviews, medication is administered as prescribed by the physician(s). Staff are trained in medication administration. LPA obtained copies of the Medication Administration Records (MARs) and reviewed medication for C-1 through C-4. Interviews conducted and reviewed documentation do not corroborate this allegation.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

Exit interview was conducted and a copy of this report and appeal rights were provided to Aura Alarcio/S-1

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC9099 (FAS) - (06/04)

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