198603538-10-26-2023-28-AS-WSHO-CXJUW2-20231113145558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603538
Report Date: 10/26/2023
Date Signed: 10/26/2023 11:45:44 AM

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
10/19/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231019134710

FACILITY NAME:	ALL IN CAREHOME		FACILITY NUMBER:	198603538
ADMINISTRATOR:	YAMASHIRO, SHELLY		FACILITY TYPE:	740
ADDRESS:	1158 BEAVER WAY		TELEPHONE:	(626) 698-9615
CITY:	LA VERNE	STATE: CA	ZIP CODE:	91750
CAPACITY:	6	CENSUS: 5	DATE:	10/26/2023
		UNANNOUNCED	TIME BEGAN:	08:47 AM
MET WITH:	Edwin Uy - Caregiver		TIME COMPLETED:	12:01 PM

ALLEGATION(S):

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Unpermitted construction on the premises.
Facility did not provide a safe environment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Edwin Uy (Caregiver) and explained the reason for the visit.

The investigation consisted of the following: LPA interviewed the Administrator (on the phone), Staff 1 - Staff 2 (S1 - S2), City of La Verne Code Enforcement Officer, Owner of the property and Resident 1 - Resident 5 (R1 - R5). LPA also conducted a tour of the facility.

The investigation revealed the following: regarding the allegation "unpermitted construction on the premises”, it is alleged that there was an unpermitted construction done in the garage. Administrator and staff stated that the room in the garage was there prior to the facility getting licensed. The owner of the property also stated the same. (Continued to LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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-20231019134710

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: ALL IN CAREHOME	FACILITY NUMBER: 198603538
	VISIT DATE: 10/26/2023

NARRATIVE

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On 12/15/2021, the Fire Department conducted a fire safety inspection as part of the facility's license application process and granted the fire clearance, and there was no mentioned of the room in the garage. The facility sketch submitted to the Community Care Licensing Division (CCLD) during the facility's license application does not show a room in the garage. The Community Care Licensing Division (CCLD) conducted a pre-licensing visit on 03/21/2022 and a follow up visit on 05/11/2022, and the room in the garage was not mentioned in the report. On 10/03/2022, the Community Care Licensing Division (CCLD) conducted a case management visit and the report states that the Licensing Program Analyst (LPA) observed a live in staff room in the garage and LPA spoke to administrator who admitted that the room was just recently built in as a storage room. The LPA did not observe any city permit and the room was not indicated on the facility sketch, and therefore a citation was issued. On 09/21/2023, the Community Care Licensing Division (CCLD) conducted an annual inspection and the report states that the Licensing Program Analyst (LPA) observed a room built inside the garage. The room was equipped with 2 beds, a closet, and there was clothing, shoes, and other personal items. A citation was issued during the annual inspection. During today's visit, LPA Mora observed the room in the garage and it has been emptied out. The City of La Verne Code Enforcement Officer stated that an inspector conducted an inspection at this facility on 10/19/2023 and confirmed that the room in the garage does not have a permit and it is unsafe. The facility was given a deadline to demolish the room by 11/19/2023.

Regarding the allegation "facility did not provide a safe environment”, it is alleged that the unpermitted room in the garage is a fire hazard due to electrical wiring installed in this enclosed structure. The City of La Verne Code Enforcement Officer stated that an inspector conducted an inspection at this facility on 10/19/2023 and deemed the room in the garage to be a fire hazard due to the electrical wiring installed. The facility was given a deadline to demolish the room by 11/19/2023. During today's visit, the LPA observed the room and the electrical wiring. LPA also observed that the room has been emptied our and no longer being used.

Based on LPA's interviews and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099-D.

Exit interview held and a copy of the report and appeal rights was provided.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231019134710

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: ALL IN CAREHOME	FACILITY NUMBER: 198603538
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/19/2023 Section Cited CCR 87305(a)	1 2 3 4 5 6 7	Alterations to Existing Building or New Facilities: (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will obtain a proper city permit for the room built inside the garage or demolish the room if not permitted by the city by 11/19/2023.
	8 9 10 11 12 13 14	Based on observation, interview, and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is a unpermitted room in the garage.	8 9 10 11 12 13 14
Type B 11/19/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation: (a)The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee will obtain a proper city permit for the room built inside the garage or demolish the room if not permitted by the city by 11/19/2023.
	8 9 10 11 12 13 14	Based on observation, interview, and record review, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. The unpermitted room in the garage has been deemed a fire hazard by a Building Inspector and Code Compliance Officer	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC9099 (FAS) - (06/04)

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