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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603570
Report Date: 05/15/2025
Date Signed: 05/15/2025 04:49:23 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
05/07/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250507161029
FACILITY NAME:PEOPLE'S CARE MCGEEFACILITY NUMBER:
198603570
ADMINISTRATOR:THOMAS, JASMINEFACILITY TYPE:
737
ADDRESS:12545 MCGEE DRIVETELEPHONE:
(909) 287-3557
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:4CENSUS: 2DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
01:28 PM
MET WITH:Jasmine Thomas - AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff conducted an improper restrained on resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegation. LPA met with Administrators Jasmine Thomas and explained the purpose of today's visit.

The investigation consisted of the following:
LPA obtained copies of facilities program design, Client #1's (C1) Physician Report, Individual Program Plan (IPP), several Special Incident Reports (SIR's) documenting incidents C1 was involved in, Corrective Action Plan from Regional Center, General Event Report from Peoples Care dated 2-19-25, and In-Service training record for CPI Holds dated 4/15/25.

(Continued on LIC9099-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: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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-20250507161029
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 MCGEE
FACILITY NUMBER: 198603570
VISIT DATE: 05/15/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Staff conducted an improper restrained on resident.
It is alleged that on 1/14/25, 1/25/25, and 2/15/25 staff performed an Advanced Physical Skills CPI specifically head stabilization on C1, of which are not approved for use in the facilities program design/Emergency Intervention Plan nor indicated in C1's IPP. LPA interviewed Administrator Jasmine Thomas where it was disclosed that this restraint did occur, and that administrator and law enforcement were present during the time of restraint. LPA reviewed facilities program design and there was nothing noted of this specific restraint being a one that facility will be utilizing on clients, additionally LPA reviewed C1's IPP and there weren't any notes stating that these are restraints staff are approved to implement for C1. LPA also reviewed the Corrective Action Plan from Regional Center, where all of the above was also revealed and what the requirements to clear the deficiency with regional center were. LPA could not conduct interview with C1 as they are no longer a client at facility and were unreachable.

Based on LPAs interview with Administrator and record review, the preponderance of evidence standard has been met, therefore the above allegation 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 a copy of this report and appeal rights will be emailed to Jthomas@peoplescare.org.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250507161029
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 MCGEE
FACILITY NUMBER: 198603570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2025
Section Cited
CCR
85165(a)
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85165 Emergency Intervention Staff Training (a) The licensee shall ensure staff who use, participate in, approve. or provide visual checks of manual restraint or seclusion only use techniques specified in the Emergency Intervention Plan and which are not prohibited in Section 85102.
This requirement was not met as evidence by:
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Facility has completed an In-Service training for CPI Holds dated 4/15/25 and provided LPA with training and list of participants and their signatures. The POC of this deficiency has been fulfilled and POC is cleared during today’s visit.
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LPA's interview with administrator revealed that staff administered a restraint on C1 that is not an allowable restraint indicated on the facility program design, LPA also reviewed the program design and did not see any notation of this restraint listed.
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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: 05/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3