198603506-7-23-2024-28-AS-DSIS-D8AU59-20240819151618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603506
Report Date: 07/23/2024
Date Signed: 07/23/2024 02:07:22 PM

Substantiated

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
06/07/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240607154239

FACILITY NAME:	REM CALIFORNIA, LLC - PENNSYLVANIA		FACILITY NUMBER:	198603506
ADMINISTRATOR:	SALAU, ADEMOLA		FACILITY TYPE:	735
ADDRESS:	11343 PENNSYLVANIA AVE		TELEPHONE:	(562) 529-2524
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	4	CENSUS: 4	DATE:	07/23/2024
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Dvette Bias - Program Supervisor		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff engaged in a verbal altercation in the presence of residents.
Staff did not provide a comfortable environment for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent complaint visit to investigate the above allegations. LPA met with Dvette Bias (Program Supervisor) & Stephanie Elam (Program Director) and explained the reason for the visit.

The investigation consisted of the following:
During the inital visit on 6/13/24 LPA obtianed copies of staff and resident rosters, interviews with 6 Staff and 4 Clients. LPA requested documentation from Staff #1's personnel file and family/emergency contact information for Clients 1-4, further investigation was needed.
During todays visit LPA delivered findings and provided copies of report and appeal rights.

(Continued on 9099-C)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

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-20240607154239

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: REM CALIFORNIA, LLC - PENNSYLVANIA	FACILITY NUMBER: 198603506
	VISIT DATE: 07/23/2024

NARRATIVE

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The investigation revealed the following:
Allegations:
Staff engaged in a verbal altercation in the presence of residents.
Staff did not provide a comfortable environment for residents.
It is alleged that S1 and S2 were involved in a verbal altercation while clients were in the home, making the environment uncomfortable and unsafe for the clients in care. LPA interviewed 6 staff and 6 out of the 6 staff confirmed that the altercation between S1 and S2 did occur and that this was in the presence of clients. Staff stated that altercation was over staff duties and a minor disagreement that turned into an argument in which S1 began to raise their voice and yell at S2. S1 and S2 stated that all clients were in their rooms, however, S2 stated there was a time where C2 was in the kitchen while the argument occurred, S1 sated C1 was in presence during the argument, both staff confirmed argument occurred in presence of clients. LPA interviewed 3 clients and 2 out of 3 clients stated that they overheard yelling and arguing between S1 and S2, both clients confirmed they were present during the argument, but neither could confirm what the argument was about. Both clients confirmed that S1 was the aggressor and they have overheard S1 yell or shout at other staff on multiple occasions. Both clients stated that they do not feel these arguments are about the clients at the home and do not feel unsafe because of these arguments, however, both clients feel these outbursts by S1 are unnecessary. Interview with S6, staff stated that S1 is currently on administrative leave and pending an investigation on this incident, where a determination on whether S1 will return for work or not will be made.

Based on LPAs observations and interviews which were conducted and record review for S1, the preponderance of evidence standard has been met, therefore the above allegation (Staff engaged in a verbal altercation in the presence of residents),is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview held and copies of the report and appeal rights were provided to Dyvette and Stephanie.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240607154239

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: REM CALIFORNIA, LLC - PENNSYLVANIA	FACILITY NUMBER: 198603506
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/23/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/06/2024 Section Cited CCR 80072(a)(1)	1 2 3 4 5 6 7	80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator to conduct a training covering Clients Personal Rights and proper staff etiquette while in the presence of clients, to ensure that clients are accorded dignity in their pesonal relationships with staff and other persons.
	8 9 10 11 12 13 14	Interviews with both staff and clients confirmed that there was a verbal altercation at the facility between S1 and S2, this altercation was in the presence of clients which did not provide clients with dignity and respect.	8 9 10 11 12 13 14	Training to be completed by POC due date and a copy of training materials and participant list with signatures to be provided to LPA via email by POC due date. tena.herrera@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2024

LIC9099 (FAS) - (06/04)

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