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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191221453
Report Date: 01/24/2025
Date Signed: 01/24/2025 04:23:27 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
12/11/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241211120028
FACILITY NAME:LUNDY FAMILY CARE HOMEFACILITY NUMBER:
191221453
ADMINISTRATOR:LUNDY, DWYANEFACILITY TYPE:
735
ADDRESS:964 N SUMMIT AVE.TELEPHONE:
(626) 794-5124
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:4CENSUS: 4DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Dwayne Lundy - Administrator
Rose Grant, Direct Support Professional		TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff handled client in a rough manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint visit for the above-mentioned allegation. LPA met with Administrator Dwayne Lundy and Rose Grant, Direct Support Professional and explained the purpose of the visit.
The investigation consisted of the following: On 12/12/2024, LPA conducted a tour of the physical plant, reviewed and obtained copies of the Client & Staff Rosters, Staff training for Zero Tolerance Policy (dated 12/07/2024), Client #1 (C1) files such as: Identification and Emergency Information (Face sheet), Functional Capability & Assessment, Admission Agreement, Physician's report, Individual Program Plan/IPP (dated 12/07/2020), Medication Administration Record (MAR) for (Oct. 2024- Dec. 2024) and Consumer Notes (Oct. 2024- Dec. 2024). LPA interviewed Staff #1 (S1) and Staff #2 (S2), no client interviews conducted as all (4) clients are in the day program during the visit. LPA attempted to call Staff #3 (S3) 2x but no calls returned. LPA requested contact information for C1's Service Coordinator/QA at Frank D. Lanterman Regional Center and copy of C1's latest IPP report. Prior to today's visit, LPA telephonically interviewed Staff #3 (S3) and Witness #1 (W1) - Witness #2 (W2).
During today’s visit, LPA obtained staff and client rosters, reviewed Staff #3 (S3) personnel file and interviewed Staff #4 (S4), Client #1 (C1) - Client #4 (C4). ***CONTINUED ON LIC9099-C***
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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-20241211120028
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: LUNDY FAMILY CARE HOME
FACILITY NUMBER: 191221453
VISIT DATE: 01/24/2025
NARRATIVE
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The investigation revealed the following:

In regards to the allegation: “Staff handled client in a rough manner.” It is alleged that a facility staff member grabbed C1’s right arm and turned C1 to ask why she was crying and whining. It is also alleged that C1 had a soft growth on her arm upon checking. (4) out of (4) staff interviewed denied the allegation. Interviewed staff stated that all the clients are treated with respect. Some staff interviewed indicated that they have seen lumps on C1's hands and left arm, but these are not a result of being mishandled. S3 denied the allegation and stated that on 12/09/2024, while in the vehicle heading to the day program, C1 was making a crying and whining noise because C1 was feeling cold, but no tears were visible on her face. Upon exiting the vehicle, S3 stated that she did not grab C1’s right arm, but rather assisted in taking off C1's backpack and helped zipped up her jacket and instructed C1 to stand in the sunlight to get warm. C1 stated that she could not remember the incident and refused to talk about it. C1 indicated that she has always had the lump on her left arm and hands for quite some time now and it is not painful. C1 stated that she is happy and feels safe in the facility. Interviews conducted with C2-C4 revealed that staff have never handled them in a rough manner, they are satisfied with the services and do not have any concerns. W1 stated that C1 was dismissed from the day program on 01/02/2025 due to C1's outburst and the potential for making false accusations, as confirmed by W2. Documents reviewed by LPA revealed that C1’s notes between Oct. 2024 – Nov. 2024 demonstrated a behavior in which C1 pretended to cry, often make loud cry noises, and wipe her eyes (no tears) numerous times. Review of S3’s personnel records indicated that she has completed the necessary training and there are no documented incidents of injuries to C1 or other clients resulting from S3 handling clients in a rough manner. During the visit, LPA observed interactions between staff and clients and did not observe anything of concern. Based on documentation reviewed and interviews conducted, there was not enough supportive evidence to corroborate the allegation.

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 and a copy of this report was provided to Rose Grant, Direct Support Professional.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2