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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603553
Report Date: 03/04/2024
Date Signed: 03/04/2024 11:50:55 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
12/27/2023 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231227121532
FACILITY NAME:TIMERS RESIDENTIAL CAREFACILITY NUMBER:
198603553
ADMINISTRATOR:WILLIAMS, SHAUNDAFACILITY TYPE:
740
ADDRESS:452 PEMBROOK AVENUETELEPHONE:
(424) 457-9771
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:6CENSUS: 4DATE:
03/04/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Shaunda Williams/S-1TIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Facility staff do not treat residents with respect.
Facility staff are not providing adequate food service to residents.
Facility staff discarded residents meals.
Facility staff left resident on the floor nfor a prolonged period of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Shauna Williams/S-1 and discussed the purpose of today's visit.

LPA conducted the initial investigation visit on 01/03/24. During this visit, LPA obtained a copy of the staff and resident rosters. LPA also reviewed files for Resident #1 (R-1) and Resident #2 (R-2) and requested relevant documentation. Ms. Williams provided the requested documentation.

During today's visit, LPA reviewed the food supply, interviewed Staff #1 (S-1) and Staff (S-2) and interviewed Resident #2 (R-2) through Resident #5 (R-5). R-1 is no longer residing at this facility.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
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 3
Control Number 28-AS-20231227121532
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: TIMERS RESIDENTIAL CARE
FACILITY NUMBER: 198603553
VISIT DATE: 03/04/2024
NARRATIVE
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Allegation: Facility staff do not treat residents with respect. Resident interviews revealed that staff treat residents with respect. Interviewed residents indicated that staff are respectful and helpful. Interviewed residents indicated staff do not yell, bully nor harass anyone. Interviewed residents indicated they do not have any concerns pertaining to this matter. Interviewed staff indicated staff treat residents with respect. Interviewed staff indicated that staff do not nor have they witnessed any staff yelling, bullying or harassing anyone. Interviewed staff indicated that R-1 has a history of fabricating stories. Interviewed staff indicated they are trained on resident rights and mandated reporting. Resident and staff interviews do not corroborate this allegation.

Allegation: Facility staff are not providing adequate food service to residents. Resident interviews revealed that staff provide adequate food service to residents. Interviewed residents indicated that they enjoy the meals that are provided at this facility. Interviewed residents indicated that they do not have any concerns pertaining to this matter. Interviewed staff indicated staff provide adequate food service to residents. Interviewed staff indicated they have not received any complaints/concerns in regards to the food service from anyone. Interviewed staff indicated that R-1 has a history of fabricating stories. LPA also observed the facility’s food supply. Resident and staff interviews do not corroborate this allegation.

Allegation: Facility staff discarded resident's meal. Resident interviews revealed that staff do not discard residents meals prior to residents finishing their meal. Interviewed residents indicated that food that is provided by staff is not expired. Interviewed residents indicated that staff offer a variety of food. Interviewed residents indicated that they do not have any concerns pertaining to this matter. Interviewed staff indicated that staff do not discard residents meals prior to residents finishing their meal. Interviewed staff indicated they have not received any complaints/concerns in regards to this matter. Interviewed staff indicated that R-1 has a history of fabricating stories. Resident and staff interviews do not corroborate this allegation.

Allegation: Facility staff left resident on the floor for a prolonged period of time. (1) out of (4) interviewed residents indicated that they have not experienced nor witnessed any residents left on the floor by staff. (2) out of (4) interviewed residents moved into this home after the alleged incident. (1) out of the (4) interviewed residents was unable to provide an answer due to a cognitive impairment. Interviewed staff indicated staff do not leave residents on the floor. Interviewed staff indicated that R-1 has a history of fabricating stories. Interviewed staff indicated they have not witnessed nor received any complaints/concerns in regards to this matter. Resident and staff interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231227121532
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: TIMERS RESIDENTIAL CARE
FACILITY NUMBER: 198603553
VISIT DATE: 03/04/2024
NARRATIVE
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Although the allegations 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.

Exit interview conducted, a copy of this report and appeal rights were provided to Shaunda Williams.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3