366411359-10-31-2022-56-AS-EMAN-CP9Q42-20230221104934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366411359
Report Date: 10/31/2022
Date Signed: 10/31/2022 12:34:41 PM

Unsubstantiated

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
10/25/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221025130852

FACILITY NAME:	GALA HOME		FACILITY NUMBER:	366411359
ADMINISTRATOR:	TOLENTINO, LILIAN MA.		FACILITY TYPE:	735
ADDRESS:	10986 GALA LANE		TELEPHONE:	(909) 902-9108
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91762
CAPACITY:	6	CENSUS: 6	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	08:46 AM
MET WITH:	Francis Pastorfide		TIME COMPLETED:	12:44 PM

ALLEGATION(S):

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Facility staff sleeping while on duty.
Facility staff allowed to work at the facility using falsified documents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegations. LPA met with Administrator Francis Pastorfide and explained the reason for the visit. At the time of the visit, there were six (6) clients, and six (6) staff present.

During today’s visit, LPA Gardner toured the facility, interviewed staff members, and interviewed clients.

For allegation, Facility staff sleeping while on duty:

LPA interviewed six (6) clients and six (6) staff. The six (6) staff stated they have never slept during a shift and they have never seen staff sleep during a shift. The six (6) clients did not respond verbally to LPA's questions regarding staff sleeping during a shift. During interviews conducted, LPA was not given information to collaborate the above allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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-20221025130852

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: GALA HOME	FACILITY NUMBER: 366411359
	VISIT DATE: 10/31/2022

NARRATIVE

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For allegation, Facility staff allowed to work at the facility using falsified documents:

LPA interviewed the six (6) staff. The six (6) staff stated they did not falsify documents to work at the facility. During interviews conducted, LPA was not given information to collaborate the above allegation. LPA reviewed staff background clearance documents and found that the staff listed in the allegation has an active background clearance to work at the facility.

Based on the information found and provided, the allegations listed above are 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, therefore the allegation is deemed unsubstantiated.

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 was discussed and provided to Administrator Francis Pastorfide, along with a copy of the appeal rights.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

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