425802105-9-29-2022-29-AS-KBUY-CJRQL5-20220930121521

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802105
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:05:30 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2022 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20220610161845

FACILITY NAME:	PEOPLE'S CARE LAKE MARIE		FACILITY NUMBER:	425802105
ADMINISTRATOR:	MARIA DRUMMOND		FACILITY TYPE:	735
ADDRESS:	2186 LAKE MARIE DR		TELEPHONE:	(805) 314-2093
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	4	CENSUS: 3	DATE:	09/29/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Leonardo Peredia/Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was shoved while in care.

Resident is being verbally abused while in care.

INVESTIGATION FINDINGS:

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At 1:30pm on 09/29/2022, Lciensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to issue final findings of the allegations above to this complaint. LPA met with Leonardo Peredia, Administrator announeced who he was and the reason for the visit.
As to the allegation of “Resident was shoved while in care.” Licensing Program Analyst (LPA) Jeffries contacted the reporting party (RP) on 09/20/2022 at 4:45pm. RP stated that Staff 9 and Staff 10 (S9, S10) reported to RP by verbal, email and text that a resident was shoved while in care. RP identified 05/12/2022 as the date period the suspected allegation took place. RP stated they did not witness Client 1 (C1) being shoved by staff. LPA noted that ten (10) regular staff, and one temporary contracted staff were scheduled at the facility during the time period of 05/01/2022 through 07/30/2022. LPA attempted to interview all staff working during this time period, S1, 2, 3, 4, 5, 6, 7, and 8. Additionally, S9, 10, and 11 could not be reached by phone on attempts made on 09/26/2022, 09/27/2022 in the AM hours and 09/27/2022 in the PM hours. S1-8 stated that they did not see or hear of any staff, at any time shove, push, hit, or being physically abusive with any of the clients at the facility. CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20220610161845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PEOPLE'S CARE LAKE MARIE	FACILITY NUMBER: 425802105
	VISIT DATE: 09/29/2022

NARRATIVE

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Documentation collected indicates that all S1, 2, 3,4, 5, 6, 7, 8, 9, 10, and 11, have been trained in reporting and documenting abuse in their initial orientation training, that included Mandated Reporter training. S9 was contracted through a staffing agency to provide staffing support, and received Mandated Reporter training through the licensee, but did not make any report of abuse pertaining to this allegation. S10 did have the Mandated Reporter training completed on 12/08/2021, however S10 did not make any report of any abuse pertaining to this allegation. LPA collaborated with Tri-Counties Regional Center on this investigation, and it was determined there was not enough evidence to prove or disprove this allegation. Based on interviews, documentation and collaborative investigation, there is not enough evidence at this time to support the allegation of, “Resident is being verbally abused while in care” and is therefore unsubstantiated at this time.

As to the allegation of, “Resident is being verbally abused while in care.” Licensing Program Analyst (LPA) Jeffries contacted the reporting party (RP) on 09/20/2022 at 4:45pm. RP stated that Staff 9 and Staff 10 (S9, S10) reported to RP by verbal, email and text that a resident was verbally abused. RP identified 05/12/2022 as the date period the suspected allegation took place. RP stated they did not witness S1 being verbally abused by staff. LPA noted that ten (10) regular staff, and one temporary contracted staff were scheduled at the facility during the time period of 05/01/2022 through July 30, 2022. LPA interviewed S1, 2, 3, 4, 5, 6, 7, and 8. Additionally, S9, 10, and 11 could not be reached by phone on attempts made on 09/26/2022, 09/27/2022 in the AM hours and 09/27/2022 in the PM hours. S1-8 stated that they did not see or hear of any staff being verbally abusive of residents while in care. S8 stated that S11 was rude and not nurturing, but never abusive with their language towards the clients. S1 stated that there was an allegation of verbal abuse that was raised during the month of June 2022. S1 was a manager at the facility at the time, and stated S9 was accused of yelling back at a client and subsequently S9 quit during that incident, S1 stating that S9 “quit on the spot.” S1 stated that there was no investigation as the Staff accused quit.

CONTINUED ON LIC9099-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20220610161845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PEOPLE'S CARE LAKE MARIE	FACILITY NUMBER: 425802105
	VISIT DATE: 09/29/2022

NARRATIVE

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LPA notes S9 was not the staff the RP accused of verbal abuse. Documentation collected indicates that all S1, 2, 3, 4, 5, 6, 7, 8, 10, and 11, have been trained in Reporting and documenting abuse in their initial orientation training, that included Mandated Reporter training. S9 was contracted through a staffing agency to provide staffing support, and received Mandated Reporter training through the licensee, but did not make any report of abuse pertaining to this allegation. S10 did have the Mandated Reporter training completed on 12/08/2021, however S10 did not make any report of any abuse pertaining to this allegation. LPA collaborated with Tri-Counties Regional Center on this investigation, and it was determined there was not enough evidence to prove or disprove this allegation. Based on interviews, documentation and collaborative investigation, there is not enough evidence at this time to support the allegation of, “Resident is being verbally abused while in care: and is therefore unsubstantiated at this time.

Exit interview, report singed, and report emailed.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022

LIC9099 (FAS) - (06/04)

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