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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603553
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:10:22 PM

Unsubstantiated


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
04/12/2024 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240412164359
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:
04/18/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Shaunda Williams TIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal items
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Shaunda Williams who assisted with today's visit.

Regarding the allegation that : Staff did not safeguard resident's personal items. The investigation consisted of interview(s) with Administrator, review of resident #1's file, including Resident Personal Property and Valuables list, and interviews with residents #2-#4. Resident #5 refused to be interviewed. Administrator stated that Resident #1 moved out of the facility on 1/13/24. Administrator stated that resident #1's personal items were taken to the hospital on about 1/23/24 and were given to resident #1's case manager. LPA observed that administrator has a video of items that were given to case manager. Administrator stated that the remainder of resident #1's items were picked up by occupational therapist from Department of Health Services on about 1/26/24. Administrator spoke to Occupational therapist during today's visit, and LPA observed that the Occupational therapist confirmed that they picked up resident #1's items from the facility.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
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-20240412164359
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: TIMERS RESIDENTIAL CARE
FACILITY NUMBER: 198603553
VISIT DATE: 04/18/2024
NARRATIVE
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Administrator stated that she does not have any of resident #1's belongings and all the belongings have been returned. Resident #2 - Resident #4 were unable to corroborate the allegation. Three out of three residents interviewed stated that facility staff do safeguard their personal belongings.

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

Exit interview conducted, and a copy of the report was provided to Ms. Williams.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2