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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603557
Report Date: 10/22/2024
Date Signed: 10/22/2024 05:09:09 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
04/22/2024 and conducted by Evaluator Alberto Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240422163541
FACILITY NAME:PEOPLE'S CARE NOGALFACILITY NUMBER:
198603557
ADMINISTRATOR:JASMIN SMITHFACILITY TYPE:
737
ADDRESS:8716 NOGAL AVENUETELEPHONE:
(909) 287-3557
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:4CENSUS: 3DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
09:58 AM
MET WITH:Jasmin Smith, Administrator TIME COMPLETED:
05:13 PM
ALLEGATION(S):
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Facility staff choked and pushed a client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez made subsequent visit to investigate the above allegation. LPA met with Administrator Jazmin Smith and discussed the purpose of the visit.

On 4/23/24 LPA Rea conducted a tour of the facility, including food supply, resident rooms, bathrooms, and common areas. The kitchen has sufficient perishable and non-perishable food. Resident rooms and common areas were properly furnished. LPA did not observe any immediate health and safety risks on today's visit. LPA observed the water temperature(s) measured between 105* F - 120* F, the facility temperature was comfortable for the residents, and electricity was operational. LPA requested and obtained copies of staff and resident roster.

On 10/22/2024, LPA Lopez interviewed two (2) clients and five (5) staff and reviewed and obtain incident report, Facility Correction Action Report, C1 Physician Report, C1 Development Evaluation Reports, IPP dated 11/30/2023, C1 face sheet, Training sign in log dated 02/07/2024 (Continued on 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20240422163541
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: PEOPLE'S CARE NOGAL
FACILITY NUMBER: 198603557
VISIT DATE: 10/22/2024
NARRATIVE
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(Continued from 9099)

Allegation: Facility staff choked and pushed a client in care. It is alleged that a staff put hands on or around the shoulder/neck area of C1 and pushed C1 with open palms.

LPA interviewed two (2) clients (C#1-C#2) and five (5) staff (S#1- S#5) LPA was unable to interview S#6 after 3 attempts and text message. Four (4) of five (5) staff stated they did not witness the incident

The investigation revealed that according to S3 who witness the incident, on 02/02/2024 at or around 3:40 PM, C1 was asking who was the lead and S2 responded by saying "I am the lead". C1 kept repeating, who is the lead over and over and S3 answered I am again and over again. According to S3, who reported witnessing the incident, C1 was agitated and wanted to get a reaction from S2, because that is how C1 is. According to S3, C1 wanted to get access to the laundry room where medications are kept under lock and key. It is reported by S3 that C1 then rushed S2 and it was it this time that S2 reacted and put S2 hands around C1 shoulder/neck area and pushed C1 away. S3 stated that S2 did not have ill intent and just reacted impulsively. S3 reported S3 got in between S2 and C1 and told C1 to stop. S3 stated S3 tried calling administrator two (2) times that day and there was no answer so S3 waited till the following Monday to report the incident. The Regional Center conducted it own investigation and substantiated the allegation. S2 denied the allegation altogether and stated that C1 has behavior issues and at one time broke S1 hand. C1 corroborated the allegation of abuse and C2 did not have any recollection of incident. C1 stated C1 did not have any visible marks or injuries and did not want go to the hospital on this day. C1 did request to go to the police station to file a report for the incident. The police did not follow up.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

Exit interview conducted with Administrator Jasmin Smith and a copy of this record and appeal rights provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240422163541
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: PEOPLE'S CARE NOGAL
FACILITY NUMBER: 198603557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2024
Section Cited
CCR
80072(a)(3)
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Personal Rights. Each client has the right to be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Licensee is to ensure that clients are protected from abuse. Licensee is to conduct in-service for all staff and turn in sign in log by POC date. S2 was terminated.
Training was conducted for all staff on February 7, 2024 and LPA reviewed and obtained training logs. ***NO FURTHER ACTION REQUIRED***
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This requirement is not met as evidenced by: S2 physically abused C1 by placing S2 hands around C1 neck and pushing C1 with open hands. It was witnessed by S3 and C1 corroborated the allegation. There were no bruising or injuries reported.
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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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3