198603489-3-15-2024-28-AS-RORN-D3RKVM-20240327081430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603489
Report Date: 03/15/2024
Date Signed: 03/15/2024 12:14:52 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
02/28/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240228090034

FACILITY NAME:	ABOVE AND BEYOND ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	198603489
ADMINISTRATOR:	SAUNDERS, TONYA		FACILITY TYPE:	735
ADDRESS:	430 S. MOUNTAIN		TELEPHONE:	(951) 323-3852
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	4	CENSUS: 4	DATE:	03/15/2024
		UNANNOUNCED	TIME BEGAN:	08:05 AM
MET WITH:	Terri Austin		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff inappropriately handled a client while in care.
Staff did not provide adequate supervision, resulting in a client biting another client.

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 byTerri 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), 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), Admission Agreement, Individual Program Plan (IPP), and other pertinent documents and physical plant tour.
SEE 9099-C for continuation.

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)

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Control Number 28-AS-20240228090034

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(s): Staff inappropriately handled a client while in care- It is alleged on 2/26/24, staff#4 (S4) was not allowing C3 to leave his room by holding C3’s bedroom doorknob. Six (6) out of six (6) staff interviewed denied this allegation. One (1) out of two (2) clients interviewed deny this allegation. Due to cognitive impairments and behavioral outbursts, client#2-3 (C2-C3) could not be interviewed. LPA Ramirez reviewed facility client daily progress notes and indicating C1 entered C3’s private room, however, it was not reported that staff held onto the doorknob as to not allow entry or exit to any client. Interviews with staff revealed C1 entered C3’s room without permission while C3 was in their room. Staff heard C3 yelling and observed C3 attempting to attack C1. Staff intervened by redirecting C1 out of C3’s room. C1 began yelling and shouting at C3 which was causing C3 to become aggressive. Staff shut the door so C3 would not see and hear C1 and de-escalate the situation. Staff revealed the situation calmed down after the door was closed and C3 eventually laid down on their bed. Staff revealed C3's door does not have a locking mechanism and staff had to stand in front of the door to prevent C1 from re-entering C3's room. Staff did acknowledge holding the doorknob of C3's door to shut closed but denied keeping the door shut as to tease C3. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Staff did not provide adequate supervision, resulting in a client biting another client- It is alleged staff do not supervise clients which resulted in C3 biting C1. Six (6) out of six (6) staff interviewed denied this allegation. One (1) out of two (2) clients interviewed deny this allegation. Due to cognitive impairments and behavioral outbursts, client#2-3 (C2-C3) could not be interviewed. LPA Ramirez reviewed four (4) client records and did not observe any medical documentation of treatment for an assault or unknown injury. C1 was last seen by their physician for a primary care appointment on 2/7/24 and no changes in treatment or current condition was observed. LPA Ramirez reviewed facility client daily progress notes dated 2/26/24 and it indicated C1 entered C3 private room, however, it was not reported that C1 was bitten by C3 nor that C1 and C3 had an altercation. Interviews with staff revealed C3 was attempting to bite C1 due to C1's uninvited entry to C3's room. Staff heard C3 yelling from their room and intervened before C3 could bite C1. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited for this visit. 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)

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