198603489-6-29-2024-28-AS-TVAO-D6RP9K-20240701110713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603489
Report Date: 06/29/2024
Date Signed: 06/29/2024 10:15:26 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
05/31/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240531144421

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: 3	DATE:	06/29/2024
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	House Manager Teri Austin		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Staff spat on client.
Staff spat in client’s food.

INVESTIGATION FINDINGS:

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*This is a corrected verison of previous 9099 dated 6/11/2024. LPA Ramirez corrected number of clients interviewed.No changes to findings.* Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 06/11/2024 regarding the above allegations. LPA Ramirez was met by House Manager Teri Austin. LPA Ramirez conducted initial complaint investigation on 06/04/2024 and needs further was documented.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 4 interviews (S1 – S4), Interview of Client#1-2 (C1-C2), Attempted interviews of Client#3-4 (C3 -C4), copies of Client#1 (C1): Admission Agreement, Identification and Emergency Information form, San Gabriel/Pomona Regional Center Individual Program Plan (IPP) , 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: 06/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2024

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-20240531144421

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: 06/29/2024

NARRATIVE

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The investigation revealed the following. Regarding Allegations: Staff spat on client- It is alleged that unknown staff spat on client. Four (4) out of the four (4) staff interviewed deny this allegation. One (1) out of the two (2) clients interviewed deny this allegation. Due to two (2) out of the four (4) clients being limited-verbal and having limited cognitive abilities, LPA Ramirez was unable to conduct interview with two (2) out of the four (4) clients. Facility does not have video surveillance in common areas of the facility. Interview with C1 revealed C1 could not recall the date when staff allegedly spat on 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.

Staff spat in resident’s food- It is alleged staff spat in C1’s food for a month or so. Four (4) out of the four (4) staff interviewed deny this allegation. One (1) out of the two (2) clients interviewed deny this allegation. Due to two (2) out of the four (4) clients being limited verbal and having limited cognitive abilities, LPA Ramirez was unable to conduct interview with two (2) out of the four (4) clients. Facility does not have video surveillance in common areas of the facility. Interview with C1 revealed C1 could not recall the date when staff allegedly spat in C1’s food. Although C1 allegedly confirmed to hearing staff spit in their food, C1 did not visually see staff spit in their food. During records review, LPA Ramirez did not observe any record any clients at the facility received medical attention due to a food borne illness or food related incident, in the last three (3) months. 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 during 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: 06/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2024

LIC9099 (FAS) - (06/04)

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