198603528-2-12-2024-28-AS-TVAO-D2MTUV-20240220140258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603528
Report Date: 02/12/2024
Date Signed: 02/12/2024 03:24:39 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
02/05/2024 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240205161306

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:	02/12/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Edgar Hernandez, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff mismanaged client’s medication.
Staff discriminated against client.
Staff did not meet client's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA met with Administrator, Edgar Hernandez, and explained the reason for the visit.

LPA toured the facility and obtained a copy of the staff roster, client roster, and documents pertaining to Client #1 (C-1). LPA also obtained a copy of the Eastern Los Angeles Regional Center (ELARC) investigative report. Interviews were held with the Administrator, Co-Administrator, 3 Staff, and 2 Clients. C-1 is no longer residing at the home and was not interviewed.

The investigation revealed the following:
Allegation – Staff mismanaged client’s medication. It was alleged that the staff did not give Client #1 (C-1) the prescribed medication.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

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-20240205161306

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: WARVALE FACILITY	FACILITY NUMBER: 198603528
	VISIT DATE: 02/12/2024

NARRATIVE

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LPA interviewed the administrator who stated that C-1 had resided at the facility as an in-home respite care service. C-1 had stayed at the facility from 9/10/23 – 9/18/23. The administrator stated that C-1 took all the medication that was provided by the mother. The medications given were documented on the medication administration record (MAR). LPA obtained a copy of the MAR log and observed staff initials on the medications given. The ELARC report indicated that the facility followed the MAR accurately and did not find that the staff did anything wrong. Staff interviewed stated C-1 was given the medications at the prescribed time and did not miss any days while C-1 was residing at the facility. Both clients interviewed stated they take their medications daily. Based on information gathered, there is no sufficient evidence to corroborate this allegation.

Allegation - Staff discriminated against resident. It was alleged that staff was being racist. LPA interviewed the administrators who stated they do not discriminate individuals based on their ethnicity. They are happy to accept any clients who are compatible with their program and can meet their needs. Administrator indicated that they accepted C-1 from 9/10/23 – 9/18/23 and took good care of the client. They did not force C-1 to do things when client refused. They properly fed C-1 and client sat with the other clients at the dining table to eat together. Staff interviewed stated they do not discriminate against any individuals. They provide the care and supervision that clients need and respect all ethnicities and background. One out of 2 clients indicated staff treat them fair and are nice.

Allegation - Staff did not meet resident's needs. Administrator and Staff interviewed stated they provide proper care and supervision for all their clients. When C-1 resided at the home from 9/10/23 – 9/18/23, staff assisted client with bathing, toileting, and grooming. Staff encouraged C-1 to perform good hygiene daily. C-1 was fed and showered prior to family member picking up client on 9/18/23. Staff indicated that with encouragement, C-1 allowed staff to help with the showering and toileting. They also stated they want to ensure all clients have good hygiene and are comfortable residing at the home. LPA interviewed 2 clients and both stated staff help them with their needs.

Although the allegations 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.

An exit interview was conducted with the administrator. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2024

LIC9099 (FAS) - (06/04)

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