366411359-2-14-2023-56-AS-EMAN-CP9Q3Z-20230221104934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366411359
Report Date: 02/14/2023
Date Signed: 02/14/2023 09:24:44 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
10/25/2022 and conducted by Evaluator Ryan Gardner

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:	02/14/2023
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Francis Pastorfide		TIME COMPLETED:	09:34 AM

ALLEGATION(S):

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Facility staff caused injuries to Clients in Care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 10/31/2022. LPA stated the purpose of the visit and was granted entry and met with Francis Pastorfide.

For allegation, Facility staff caused injuries to Clients in Care:

The investigation was conducted by IB Investigator which included a review of resident’s (R1, R2, R3, R4, R5, and R6) facility records, interviews conducted with Inland Regional Center, interviews conducted with six (6) facility staff, and records obtained from the police department.

During interviews conducted with Inland Regional Center, IB investigator found that they did their own internal investigation into the alleged allegation. Inland Regional interviewed the Suspected Abuser (SA) and the six (6) facility staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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-20221025130852

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: GALA HOME	FACILITY NUMBER: 366411359
	VISIT DATE: 02/14/2023

NARRATIVE

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Inland Regional found that the interactions between the residents and the SA were both positive and caring and did not show signs of abuse. The Inland Regional Center’s investigation found that there was not substantial evidence to prove the allegation occurred.

During the interview conducted with the SA, the SA denied the allegation, explained how good their interactions were with the residents, and explained how all the residents enjoyed being around the SA. The SA assumes that the allegation was made due to retaliation from a prior staff losing their job.

During interviews with the staff, there were no concerns of abuse or neglect regarding the SA. The staff did not see any abuse or any signs of abuse from the SA. The six (6) staff all stated that the interactions between the residents and the SA were positive and caring.

Overall, during the investigation, there was not substantial evidence to collaborate the allegation.

Based on evidence obtained, the IB Investigator deemed the allegation listed above 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 Francis Pastorfide, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC9099 (FAS) - (06/04)

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