198602123-12-19-2023-28-AS-TVAO-CYS2B3-20231222161429

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602123
Report Date: 12/19/2023
Date Signed: 12/19/2023 11:21:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/12/2023 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231212115924

FACILITY NAME:	PEOPLE'S CARE CAMERON		FACILITY NUMBER:	198602123
ADMINISTRATOR:	MARGIE KIMBLE		FACILITY TYPE:	735
ADDRESS:	2441 CAMERON AVE		TELEPHONE:	(626) 732-3500
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	4	CENSUS: 2	DATE:	12/19/2023
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Margie Kimble- Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff threatened a client while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Margie Kimble and explained the reason for the visit.

The investigation consisted of the following: LPA Flores requested a copy of staff and client roster. Interviewed two (2) staff, one (1) client, and requested copies of physician’s report, identification and emergency information sheet, needs and service plan, personal rights, consent forms, grievance procedures and explanation form, rights of individuals with developmental disabilities, admission agreement, IPP, health care plan, and for C1.

The investigation revealed the following: Regarding allegation: Staff threatened a client while in care. It is alleged staff repeatedly were threatening client to call the cops due to client’s behavior. Interviews conducted revealed; Client stated to not have been threaten by staff and to have good relationships with staff. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

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 28-AS-20231212115924

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PEOPLE'S CARE CAMERON	FACILITY NUMBER: 198602123
	VISIT DATE: 12/19/2023

NARRATIVE

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Interviews with staff revealed staff do not threaten the clients while in care. Administrator explained the following, there have been inappropriate behaviors observed from the client towards the female staff, after those behaviors were observed, the administrator spoke to the client. During that conversation on a calm setting client was made aware that if the inappropriate behaviors were to continue the staff will have to report the behaviors to the police due to the nature of the behaviors. Administrator or other staff did not threaten client during a behavior or to stop client from the behavior happening. Instead had a discussion after client was calm to make client aware that the behaviors are reportable to the police. Documents review revealed client has a history of inappropriate behaviors. Although an incident report was not created for the behaviors, those were recorded on the therap notes.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Margie Kimble and a copy of this report was provided via email due to technical issues.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (818) 419-8131
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023

LIC9099 (FAS) - (06/04)

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