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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603489
Report Date: 01/12/2023
Date Signed: 01/12/2023 10:29:24 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
01/04/2023 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230104143057
FACILITY NAME:ABOVE AND BEYOND ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
198603489
ADMINISTRATOR:SAUNDERS, TONYAFACILITY TYPE:
735
ADDRESS:430 S. MOUNTAINTELEPHONE:
(951) 323-3852
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:4CENSUS: 3DATE:
01/12/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Darlene Cetera "Williams"/S-1TIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff not providing clients medication as prescribed.
Clients records incomplete.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial 10-day complaint visit to investigate the above allegations. LPA was allowed entry by Darlene Centera "Williams". LPA explained the purpose of today's visit.

During this visit, LPA obtained a copy of the Staff Roster, Client Roster, reviewed file for C-1 and obtained relevant documentation. LPA interviewed Staff #1 through Staff #3 (S-1 through S-3). LPA left a message for Staff #4 (S-4) for a return call. LPA was unable to interview Client#1 (C-1) as C-1 is deceased. LPA attempted to interview Client #2 (C-2) and was unsuccessful as C-2 did not understand the interview questions. LPA was unable to interview Client #3 (C-3) and Client #4 (C-4) as both are non-verbal.

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: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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 2
Control Number 28-AS-20230104143057
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: ABOVE AND BEYOND ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 198603489
VISIT DATE: 01/12/2023
NARRATIVE
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Allegation: Staff not providing clients medication as prescribed. During this investigation, LPA reviewed C-1's file and obtained relevant documentation. LPA was unable to interview Clients (C-1 is deceased, C-2 did not understand interview questions and C-3 and C-4 are non-verbal). LPA interviewed Staff #1 through Staff #3 (S-1 through S-3). LPA left a message for Staff #4 (S-4) for a return call. Staff interviews revealed clients are provided with their medication as prescribed. Staff interviews indicated they do not provide clients with "extra medication". Staff interviews and file review do not corroborate this allegation.

Allegation: Clients records incomplete. During this investigation, LPA reviewed C-1's file and obtained relevant documentation. LPA was unable to interview Clients (C-1 is deceased, C-2 did not understand interview questions and C-3 and C-4 are non-verbal). LPA interviewed Staff #1 through Staff #3 (S-1 through S-3). LPA left a message for Staff #4 (S-4) for a return call. Staff interviews revealed that staff complete daily notes for all the clients. Interviewed staff indicated they have not been asked to "redo" the notes that staff have entered. Staff interviews and file review do not corroborate this allegation.

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 conducted and appeal rights and a copy of this report was provided to Darlene Centera "Williams".
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2