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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603489
Report Date: 03/15/2024
Date Signed: 03/15/2024 12:15:42 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
02/27/2024 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240227160455
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: 4DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
08:07 AM
MET WITH:Direct Support Staff Terri AustinTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff hit clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 3/15/2024 to deliver findings. Initial complaint investigation was conducted on 03/04/2024 by LPA Ramirez and needs further investigation was documented. LPA Ramirez was met by Terri Austin and explained the purpose of the visit.
The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster, Client Roster (LIC 9020), Staff #1-5 interviews (S1 – S5), copies of Staff #4-6 (S4-S6) Employment Application, interview of Clients#1,4 (C1,C4), attempted interview of Clients#2-3 (C2-C3), attempted interview of Claremont Police Officer Kelly, review of clients#1-4 client records, copies of clients #1,2,3 (C1- C3) Physician’s report, face sheet, Client daily progress notes, Unusual Incident Reports (LIC 624) San Gabriel/Pomona Regional Center Corrective Action Plan dated 3/12/24, Admission Agreement, Individual Program Plan (IPP), and other pertinent documents and physical plant tour.

SEE 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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 2
Control Number 28-AS-20240227160455
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: 03/15/2024
NARRATIVE
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The investigation revealed the following. Regarding Allegation: Staff hit clients in care- It is alleged staff#5 (S5) hit C1 and C2. Six (6) out of six (6) staff interviewed denied this allegation. One (1) out of the two (2) clients interviewed denied this allegation. C1 confirmed to LPA Ramirez that S5 hit C1 and C2 but C1 could not recall the day or time it happened. C1 could not recall to LPA Ramirez any injuries sustained. LPA Ramirez attempted to interview C2 and C3 however, due to cognitive impairments, LPA Ramirez was unable to conduct interviews. LPA Ramirez reviewed all clients records, including Unusual Incident Report (LIC 624), client progress daily notes and medical follow-up reports, and did not observe any documentation that would suggest clients’ received medical attention for an injury or assault. LPA Ramirez reviewed LIC 624 dated 02/27/24, that indicated Claremont police Officer Kelley was dispatched and documented the alleged incident. LPA Ramirez attempted to contact Officer Kelley but was unable to conduct interview. LPA Ramirez reviewed San Gabriel/Pomona Regional Center (SGPRC) Corrective Action Plan(CAP) dated 3/12/24, which indicated an investigation was initiated in response to a complaint filed regarding the above allegation. According to the CAP, SGPRC received clearance from Claremont Police to proceed with their own investigation and based upon that investigation; interviews and records reviewed revealed the allegation was not substantiated. Review of C1's IPP revealed C1 has a history of fabricating stories. Although the allegation 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.

No deficiency is being cited for this investigation. Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2