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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197606410
Report Date: 12/01/2022
Date Signed: 12/01/2022 10:16:05 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/30/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221130130601
FACILITY NAME:CARING PARTNERS, INCFACILITY NUMBER:
197606410
ADMINISTRATOR:TERESA SANTOSFACILITY TYPE:
740
ADDRESS:19607 WIERSMA AVENUETELEPHONE:
(562) 333-8141
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 4DATE:
12/01/2022
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Ed Francisco TIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Staff neglect led to resident sustaining multiple pressure injuries
Resident sustained multiple UTIs while in cares.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint investigation regarding the above allegations. LPA Wong met with DSP Karla Serrano and explained the reason of the visit and shortly after, the administrator Ed Francisco arrived.

On today's visit, LPA Wong conducted a health and safety check and reviewed residents' roster. LPA also toured physical plant with Karla, and toured all four residetns' rooms and observed three residetents (R2-R4) in the faciltiy. LPA also interviewed staff#1 (S1) in the facility and administrator via phone. Due to the facility is affliated with Regional Center and LPA also interviewed the Quality Assurance (QA) and confirmed that Resident#1 (R1) did not reside in the faciltiy. LPA also spoke to the Reporting Party (RP) and confirmed R1 did not resident at tha above facility.

(See LIC 9099C for continuation)
Unfounded
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
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 2
Control Number 28-AS-20221130130601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CARING PARTNERS, INC
FACILITY NUMBER: 197606410
VISIT DATE: 12/01/2022
NARRATIVE
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Based on interview and document reviewed, Resident #1 (R1) did not reside at this facility. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

An exit interiew conducted and a copy of the report was provided to Administrator Ed Francisco
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2