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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603538
Report Date: 03/15/2024
Date Signed: 03/15/2024 01:09:07 PM

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
02/27/2024 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240227160538
FACILITY NAME:ALL IN CAREHOMEFACILITY NUMBER:
198603538
ADMINISTRATOR:YAMASHIRO, SHELLYFACILITY TYPE:
740
ADDRESS:1158 BEAVER WAYTELEPHONE:
(626) 698-9615
CITY:LA VERNESTATE: CAZIP CODE:
91750
CAPACITY:6CENSUS: 5DATE:
03/15/2024
UNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:CaregiverGloria EstroboTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff left the residents unattended while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 3/X15/2024 to deliver findings. Initial complaint investigation was conducted on 03/07/2024 by LPA Ramirez and needs further investigation was documented. LPA Ramirez was met by Gloria Estrobo and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident Roster (LIC 9020), Staff Roster (LIC 500), Staff#1 - 3 interviews(S1 – S3), interview of Witness#1-2 (W1-W2) copy of Staff#2-3 (S2-S3) Personnel Record (LIC 501), Attempted interview of Resident#1-6 (R1-R6), Resident# 1-6 (R1- R6) review of resident records, copies of Resident#1-5 Physician’s Report, and physical plant tour.

See 9099-C for continuation.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
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-20240227160538
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: ALL IN CAREHOME
FACILITY NUMBER: 198603538
VISIT DATE: 03/15/2024
NARRATIVE
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The investigation revealed the following. Regarding Allegation: Staff left the residents unattended while in care- It is alleged staff left residents unattended on 2/21/24, around 5:30pm. Interview with W1 revealed on 2/21/24, around 5:30 pm, W1 made several attempts by ringing the facility doorbell and knocking on facility front door, to gain entry into the facility. W1 looked through the facility window and could see R1 sitting in their wheelchair and sitting at the kitchen table area. W1 revealed staff were not seen nearby after making several attempts to gain entry into the facility. W1 stated eventually an unknown young male (W2) answered the door and allowed W1 entry into the facility. W1 revealed they did not see any known staff in the facility for approximately 15 minutes after their arrival. Three (3) out of the three (3) staff interviewed deny this allegation. W2 denied this allegation. W2 stated staff#2 (S2) was in the facility garage area, tending to the laundry while W2 answered the door. W2 revealed all residents in care were in their rooms when W1 was allowed entry into the facility. It was revealed through records review and interviews that W2 is a minor child of S3. W2 revealed to LPA Ramirez that W2 was waiting for S3 to return to the facility but that S2 was in the facility garage when W1 arrived. Due to cognitive impairments, R1-R5 could not be interviewed. R6 no longer resides at the facility and was unable to be interviewed. LPA Ramirez did not observe video surveillance in common areas of the facility. According to Administrator Yamashiro, staff do not have timecards to clock in and out of their shifts. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiency is being cited today. Exit interview was conducted and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2024
LIC9099 (FAS) - (06/04)
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