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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330902477
Report Date: 08/22/2023
Date Signed: 08/22/2023 02:56:33 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2023 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20230818130147
FACILITY NAME:PASS RESOURCE CENTERFACILITY NUMBER:
330902477
ADMINISTRATOR:DUNCAN, PATFACILITY TYPE:
775
ADDRESS:702 EAST 11TH STREETTELEPHONE:
(951) 845-3385
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:80CENSUS: 28DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Pat Duncan -Administrator TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff released client to an individual not authorized by client’s legal representative.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegation. LPA Allen met with Pat Dunca who was informed of the purpose of visit.

LPA conducted an interview with the administrator Pat Dunca,C1's responsible party and reviewed C1's facility file.
LPA reviewed C1's file and it revealed that there is only one (1) authorized representative allowed to pick up C1 from the day program. The interview with the administrator stated that the facility staff did allow an unauthorized individual to leave the facility with C1without premission from C1's responsible party.

Based on the records reviewed and interview with Pat the above allegation is Substantiated.A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is being cited on the attached LIC 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 56-AS-20230818130147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: PASS RESOURCE CENTER
FACILITY NUMBER: 330902477
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2023
Section Cited
CCR
82078(a)
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82078 Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement. This requirement is not met as evidenced by:
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The licensee has agreed to read and provide a signed statement of understanding of the regulation cited signed by all staff members by the POC date of 8/30/2023.
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Based on interviews, and record review, the licensee did not ensure that C1 left the faciltiy with an authorized representative. This poses an pentntial Health, Safety, or Personal Rights risks to persons in care.
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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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2