366411355-8-8-2023-56-AS-EMAN-CUSQWP-20230817123217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366411355
Report Date: 08/08/2023
Date Signed: 08/08/2023 11:05:19 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-20230622114045

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:	11:15 AM

ALLEGATION(S):

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Staff handled resident in a rough manner.

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, Staff handled resident in a rough manner:

Interview with Staff (S1) revealed that they used a CPI hold on client (C1) on 6/20/2023 to protect the staff, other clients, and IRC-CSC from a dangerous situation. S1 attempted to use talking, distracting, and redirection prior to using the CPI hold. Once C1 calmed down, the CPI hold ended. S1 denied using the CPI hold in a rough manner.

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-20230622114045

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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Interview with Inland Regional Center CSC (IRC-CSC) revealed that they were present in the facility when the CPI hold with C1 occurred. IRC-CSC stated that the CPI hold was not used in a rough manner with C1. The CPI hold was used to protect the staff and other clients from a dangerous situation. The CPI hold, along with talking to C1, calmed the client down, and deescalated the situation.

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 dangerous situations. 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 and methods annually to ensure the staff are up to date on how to properly use CPI with the clients. Document review of a special incident report (SIR) sent to State Licensing on 6/26/2023 revealed that a CPI hold was used on C1 on 6/20/2023. The SIR details the events leading up to and after the CPI hold. The SIR’s details the same information that was revealed during interviews in this investigation.

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

Based on evidence obtained during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

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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