366411355-8-8-2023-56-AS-EMAN-CUSR2Q-20230817123843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366411355
Report Date: 08/08/2023
Date Signed: 08/08/2023 11:01:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230622154416

FACILITY NAME:	PALMETTO FAMILY HOME		FACILITY NUMBER:	366411355
ADMINISTRATOR:	CARDEN, LORI		FACILITY TYPE:	735
ADDRESS:	9169 PALMETTO AVENUE		TELEPHONE:	(909) 854-5398
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY:	6	CENSUS: 6	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Laporsha Grant-Facility Manager		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Facility is not providing sufficient food to clients in care.
Staff is aggressive with the clients in care.
Staff is verbally abusive to the clients in care.
Staff does not use restraint techniques appropriately.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to issue findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Facility Manager Laporsha Grant. The investigation consisted of client interviews, staff interviews, and document review.

For allegation, Facility is not providing sufficient food to clients in care:

Interviews with staff and clients revealed that the clients are served lunch, breakfast, dinner, and snacks throughout the day. The clients are not restricted to a certain amount of food and can request more food whenever they are hungry. Interviews with staff, interviews with clients, and review of the facility menu revealed that the clients are served a variety of proteins, vegetables, carbohydrates, and fruits. Observation of the food supply revealed that the facility has the appropriate amount of perishable and non-perishable food supply required.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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-20230622154416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PALMETTO FAMILY HOME	FACILITY NUMBER: 366411355
	VISIT DATE: 08/08/2023

NARRATIVE

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For allegation, Staff is aggressive with the clients in care:

Interviews with clients and staff revealed that the staff are not aggressive with the clients. The staff denied being physically aggressive with the clients. The staff stated that they treat the clients with care, dignity, and respect. The clients denied being physically abuse by the staff. The clients feel safe in their home and are not afraid of the staff.

For allegation, Staff is verbally abusive to the clients in care:

Interviews with clients and staff revealed that the staff are not verbally abusive to the clients. The staff denied yelling at the clients. The staff denied using inappropriate language with the clients. The clients stated they are not yelled at or called inappropriate names. The clients feel like they are spoken to in caring and considerate manner.

For allegation, Staff does not use restraint techniques appropriately:

Interviews with clients and staff revealed that the facility uses Crisis Prevention and Intervention (CPI) holds on the clients. The staff use CPI holds on the clients when the staff needs to protect themselves from a dangerous situation. The staff denied using CPI holds when it was not necessary to protect themselves. The staff will attempt to deescalate the client’s behavior with talking, distracting, and redirection prior to using a CPI hold. The CPI holds are used as a last resort. The clients stated that they don’t think that the staff are using CPI holds inappropriately or in a rough manner. The clients stated that the staff only uses CPI holds when its necessary to calm a client down and it is not done in a rough manner. Document review revealed that the staff are trained on CPI holds annually to ensure they are up to date on how to properly use the hold methods.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the four (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230622154416

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PALMETTO FAMILY HOME	FACILITY NUMBER: 366411355
	VISIT DATE: 08/08/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Facility Manager Laporsha Grant, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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