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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425802105
Report Date: 04/11/2025
Date Signed: 04/11/2025 10:58:52 AM

Substantiated


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
01/23/2025 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20250123083439
FACILITY NAME:PEOPLE'S CARE LAKE MARIEFACILITY NUMBER:
425802105
ADMINISTRATOR:REA BONNER HALLMONFACILITY TYPE:
735
ADDRESS:2186 LAKE MARIE DRTELEPHONE:
(805) 314-2093
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:4CENSUS: 4DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Rea Bonner HallmonTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff handled resident in a rough manner.
Staff speaks inappropriately to resident.
INVESTIGATION FINDINGS:
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 At 10:30am am on 04/11/2025, Licensing Program Analyst (LPA) Jeffries arrived to the facility unannounced to issue final findings to the allegations to this complaint. LPA met with facility Administrator Rea Bonner Hallmon, announced who he is and the reason for the visit. LPA issued the following final findings to all allegations to this complaint and citation, as follows:
As to the allegation of, “Staff handled resident in a rough manner.” and “Staff speaks inappropriately to resident” It was alleged that, Client 1 (C1) was held down by Staff 4 (S4) and pulled out of bed by C1’s feet. It was discovered through Case Management Visit on 04/24/2024, and documentation and interviews conducted by LPA Jeffries and QA Magana (TCRC). On 01/28/2025 in an interview with C1 who stated that they, “were pulled out of bed to the floor by (S4) and hurt their back.” In an interview by LPA Phillips on 04/24/2024 with C1 during a case management visit, C1 stated “(S4) had pushed them off their bed onto the floor. C1 stated that S4 then told them not to tell anyone about the incident including the Administrator or House Manager. C1 stated that they were sleeping and S4 physically pushed/pulled
CONTINUED on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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-20250123083439
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: 04/11/2025
NARRATIVE
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 them off the bed causing back pain when they hit the floor. On 04/09/2024 this facility submitted a Serious Incident Report to CCLD for the related incident that took place on 04/01/2024, stating, 04/01/2024 “staff dragged her from her feet off her bed as she was laying down and dropped her to the ground, which led to her hurting her back.” On 01/28/2025, LPA Jeffries collected facility Administrative Leave Notification for S4 which was dated 04/08/2024 indicating that S4 was put on administrative leave due to the allegations of client abuse of the incident on 04/01/2024. On 04/09/2025 LPA Jeffries contacted facility Administrator, and Peoples Care District Manager to verify that S4 has not returned back to work since 04/08/2024. Based on interviews and documentation there is enough evidence to support the allegations of, “Staff handled resident in a rough manner.” and “Staff speaks inappropriately to resident” both are substantiated at this time.


Exit interview, report read, violations cited, appeal rights and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20250123083439
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/14/2025
Section Cited
CCR
80072(a)(1)
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Personal Rights 80072 (a) ...each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.. This requirement was not met by evidence of S4 pulling C1 from bed
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Verity that all staff that are currently employed at the facility have personal rights and CPI training that are current. Email LPA Jeffries before the close of business on 04/14/2025.
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falling to the floor, which put clients in care in eminent danger.

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Deficiency Dismissed
Type B
04/25/2025
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) … each client shall have personal rights which include…the following:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including…
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Schedule personal rights training focusing on client communications and responsible medical attention in a timely matter. All training must be completed by 04/25/2025 and verification emailed to LPA by close of business on 04/25/2025.
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interference with the daily living functions, including eating, sleeping, … This requirement was not met by evidence of S4 telling C1 not to inform leadership of pulling from the bed. Which puts clients in care in potentail danger.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3