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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603806
Report Date: 11/19/2024
Date Signed: 11/19/2024 02:51:11 PM

Substantiated


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
11/12/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241112145041
FACILITY NAME:EASTERSEALS ADULT DAY SERVICESFACILITY NUMBER:
198603806
ADMINISTRATOR:VASQUEZ, ERICKFACILITY TYPE:
775
ADDRESS:1223 E ROUTE 66TELEPHONE:
(626) 856-1601
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:50CENSUS: 40DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Erick Vasquez, Program DirectorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff did not assist client with incontinence needs in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with Administrator Erick Vasquez.

The investigation consisted of: a physical plant tour, record review, and interviews with staff (S1-S4) and clients (C2-C5). Client (C1) is non-verbal and is no longer a participant of the day program. Copies of C1's Face Sheet, Physician's Report, Health Condition Care Plan, Intake Form, IPP, Physician's Order, PRN Authorization Letter, T-Log, 5 Refresh Check-Off Lists, C1's Daily Log, Program Narrative, LIC 500 Personnel Report, staff schedule, and client roster were obtained.

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
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 5
Control Number 28-AS-20241112145041
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: EASTERSEALS ADULT DAY SERVICES
FACILITY NUMBER: 198603806
VISIT DATE: 11/19/2024
NARRATIVE
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Allegation: Staff did not assist client with incontinence needs in a timely manner. The complaint alleges that for 5 days in a row [dates unknown] staff may have only changed client (C1) once between the hours of 8:30 AM - 1:30 PM. The client was always sent with 5 diapers and 5 chucks, but during that week the client returned home with 3-4 diapers. According to information obtained, C1 typically urinated at least 4 times within a 5 hour period, which would have required the use of all 5 diapers sent to the day program. A total of 4 clients were interviewed. They all stated they observe staff providing incontinence assistance. Client (C1) is non-verbal and was not interviewed. Based on interviews and record review, the investigation revealed that lead Life Skills Coach (S1) and relief staff (S2) were initially checking C1 every 15 minutes, then proceeded to check the participant every hour, but during incontinence assistance staff observed that C1 was soiling through. Therefore, both staff started checking C1 every 30 minutes. All staff denied any negligence with incontinence assistance. Staff stated that clients are provided incontinence assistance, and client (C1) was typically changed three times during programming. However, based on record review of T-Log, 5 Refresh Check-Off Lists, and C1's Daily Log staff did not consistently document that checks and assistance was being provided to C1 and other clients. The facility uses Therap Services software, in which only 2 entries pertaining to C1's incontinence care was referenced. LPA requested plan of operation and continence care manage plan, but a year 2000 Program Narrative was provided that did not include a continence plan.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

An exit interview was conducted with Program Director Erick Vasquez . A copy of the report and appeal rights were issued.


NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20241112145041
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: EASTERSEALS ADULT DAY SERVICES
FACILITY NUMBER: 198603806
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/10/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement was not met evidenced by:
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Licensee shall:
1. Review the program continence plan
2. Submit written POC
3. Conduct staff training on incontinence care responsibilities and documentation.

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Based on record review, 5 facility Refresh Check-off List records were obtained, in which 2 out 5 days there was no documentation of care assistance/checks did not to document any continence care was provided, which poses a potential health and safety risk.
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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: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
11/12/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241112145041

FACILITY NAME:EASTERSEALS ADULT DAY SERVICESFACILITY NUMBER:
198603806
ADMINISTRATOR:VASQUEZ, ERICKFACILITY TYPE:
775
ADDRESS:1223 E ROUTE 66TELEPHONE:
(626) 856-1601
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY:50CENSUS: 40DATE:
11/19/2024
UNANNOUNCEDTIME BEGAN:
08:43 AM
MET WITH:Erick Vasquez, Program DirectorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Licensee did not maintain staffing ratios as contracted for client.
Staff did not ensure client was provided lunch.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegations listed above. LPA discussed the purpose of the visit with Administrator Erick Vasquez.

The investigation consisted of: a physical plant tour, record review, and interviews with staff (S1-S4) and clients (C2-C5). Client (C1) is non-verbal and is no longer a participant of the day program. Copies of C1's Face Sheet, Physician's Report, Health Condition Care Plan, Intake Form, IPP, Physician's Order, PRN Authorization Letter, T-Log, 5 Refresh Check-Off Lists, C1's Daily Log, Program Narrative, LIC 500 Personnel Report, staff schedule, and client roster were obtained.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20241112145041
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: EASTERSEALS ADULT DAY SERVICES
FACILITY NUMBER: 198603806
VISIT DATE: 11/19/2024
NARRATIVE
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Allegation: Licensee did not maintain staffing ratios as contracted for client. It is alleged that the day program is not providing one-to care to participant/client (C1) because different staff were observed with the client at pick-up time. According to information obtained, the day program has a ratio of 1 staff per 3 clients, but client (C1) requires 1 to 1 supervision. Client (C1) was admitted to the program on 10/7/24 and discharged on 10/31/2024. A total of four (4) staff were interviewed, which included the two staff assigned to C1's one to one care. All staff denied the allegation. They stated that the client always had one-to-one care, and when C1's primary Life Skills Coach (S1) was out to lunch staff (S2) was assigned the care and supervision responsibility. If C1's primary and secondary staff were off or on break, then the day program assigns other staff that fill in with the 1 to 1 care. Per program Administrator, the day program employs 23 staff persons, and clients that require 1 to 1 care always receive required personal care and supervision. Regional Center Service Coordinator was interviewed and confirmed that the day program is funded for 1 to 1 care for client (C1), and most clients in the program have a 3 to 1 ratio. Based on interviews conducted and record review, the findings indicate the day program always provided 1 to 1 care and supervision for client (C1). Therefore, there is insufficient evidence to corroborate the allegation.

Allegation: Staff did not ensure client was provided lunch. It is alleged that on 10/30/24 & 10/31/24, staff did not ensure client (C1) was fed lunch because they returned home with a full lunch pail. Of concern is that C1 requires administration of 1 noon medication that needs to be given within half hour of lunch meal. All staff and clients interviewed denied the allegation. Clients said that clients that require feeding assistance are always fed. Client (C1's) 1 to 1 care staff stated that when the client was first admitted to the program their mother instructed staff to feed the client all the food that was packed, and to tilt the client's head back and force feed the client. Life Skills coaches explained to C1's mother that they felt uncomfortable with following her feeding instructions, and that per program policy when a client pushes away the food or communicated, they did not want to be fed or eat, then staff would stop feeding the client. Per, Administrator the program provides person-centered services that includes supporting individuals to make their own decisions. Client (C1) is non-verbal but can communicate their likes and dislikes. According to staff interviews, C1 disliked pureed bananas. The client's medication was initially being given with the pureed bananas, but based on staff observations it was determined that the medication would be administered with chocolate pudding instead. Staff reported that C1's family often sent large amounts of food and water, but C1 did not always want to eat specific foods or the large amounts. During today’s visit, clients were observed being assisted with lunch meals. There is insufficient evidence to corroborate the allegation.

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.



Exit interview conducted with Program Director Erick Vasquez. A copy of the report was issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5