198603528-2-3-2023-28-AS-FFIS-CS7MEX-20230526093324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603528
Report Date: 02/03/2023
Date Signed: 02/03/2023 05:05:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/02/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230202155430

FACILITY NAME:	WARVALE FACILITY		FACILITY NUMBER:	198603528
ADMINISTRATOR:	HERNANDEZ, YESSICA		FACILITY TYPE:	735
ADDRESS:	8740 WARVALE ST.		TELEPHONE:	(323) 346-3450
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	4	CENSUS: 2	DATE:	02/03/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Staff#2, Edgar Hernandez		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff caused bruises to client in care.
Staff assaulted client in care.
Staff yelled at client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegations listed above today. During today’s visit, LPA met staff, Edgar Hernandez, and spoke with Administrator, Yessica Hernandez, over the phone. LPA explained the purpose of today's visit regarding the above-mentioned allegations.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of clients from client#2 (C2) through client#3 (C3) and client#1's family member#1 (F1); reviewed client#1’s record reviews, and a facility tour. LPA obtained copies of staff and client rosters; client#1’s police’s report, dated 1/11/23, and client files of client#1 (R1) with relevant information.

In regard of the allegation that “staff caused bruises to client in care,” it was alleged that staff#2 (S2) hit client#1 (C1) and caused bruises on C1’s body. The investigation revealed the following: LPA was unable to interview client#1 (C1) since C1 was currently in a mental hospital. (-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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-20230202155430

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: WARVALE FACILITY	FACILITY NUMBER: 198603528
	VISIT DATE: 02/03/2023

NARRATIVE

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Interviewed with clients from client#2 (C2) through client#3 (C3) revealed that staff did not hit client and caused bruises. Four (4) out of four (4) staff, including client#1’s service coordinator, denied the allegation. LPA interviewed C1’s conservator, family member (F1). F1 did not corroborate the allegation. Therefore, there is not a preponderance evidence to prove staff hit client#1 and caused bruises on client’s body.

In regard of the allegation that “staff assaulted client in care,” it was alleged that on 1/11 /23, staff#2 (S2) grabbed client#1 (C1) by the neck, hit C1 in the arm while staff#3 (S3) threw C1 to the ground, hit C1 in the face, and threw water on C1. The investigation revealed the following: LPA was unable to interview client#1 (C1) since C1 was currently in a mental hospital. Interviewed with clients from C2 through C3 and F1 revealed that staff did not assault client. Four (4) out of four (4) staff denied the allegation. File review revealed that, on 1/11/23, client#1 (C1) was picked up by police sheriffs and sent to a mental hospital for a 51/50 due to client hit staff and damaging property. Staff#4 (S4) stated that administrator notified regional center on 1/11/23 by filing an incident report. An incident report was filed to Licensing as well. Therefore, there is not a preponderance evidence to prove staff assaulted client#1 while in care.

In regard of the allegation that “staff yelled at client in care,” it was alleged that on 1/10 /23, staff yelled at client#1 (C1) and broke cups and plates. The investigation revealed the following: LPA was unable to interview client#1 (C1) since C1 was currently in a mental hospital. Interviewed with clients from C2 through C3 and F1 revealed that staff did not yell at C1 while C1 was in care at the facility. Four (4) out of four (4) staff denied the allegation. Therefore, there is not a preponderance evidence to prove staff yelled client#1 while in care.

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 are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with S2, Edgar Hernandez. A hard copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC9099 (FAS) - (06/04)

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