191222631-10-31-2022-28-AS-RORN-CLLSAX-20221128124303

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191222631
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:37:31 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
10/25/2022 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221025144909

FACILITY NAME:	NELVILLE GUEST HOME		FACILITY NUMBER:	191222631
ADMINISTRATOR:	HERMINIA DELACRUZ		FACILITY TYPE:	735
ADDRESS:	2005 E. ORANGE GROVE BLVD.		TELEPHONE:	(626) 791-1170
CITY:	PASADENA	STATE: CA	ZIP CODE:	91104
CAPACITY:	6	CENSUS: 4	DATE:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	02:35 PM
MET WITH:	Administrator, Herminia DelaCruz		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility administrator yells at clients

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Bennette Pena conducted an unannounced complaint visit in order to render findings for the above allegation. LPA met with DSP II, Jaime Escano who allowed LPA entry. Shortly after, the Administrator, Herminia DelaCruz greeted LPA and discussed the purpose of today's visit.

The investigation consisted of the following: LPA obtained staff/resident roster, staff and client interviews, review of clients records, daily log notes (ID notes) and incident reports.
**********CONTINUATION 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: 10/31/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20221025144909

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: NELVILLE GUEST HOME	FACILITY NUMBER: 191222631
	VISIT DATE: 10/31/2022

NARRATIVE

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Regarding the allegation: Facility administrator yells at clients

The investigation revealed the following: LPA interviewed six (6) staff (S1-6) and all of them denied the allegation. LPA attempted to call two (2) other staff (S7-8)) three times (3x) but was unable to return LPA's telephone calls. S1 stated that she does not yell at clients or the staff. S1 stated that she talks with a loud voice and she speaks with a firm tone so she can re-direct the clients' behaviors. S1 stated that the facility has 2 clients (C1-2) who needed to be spoken with in a firm way otherwise they will not listen. S1 stated that C1-2 are perseverating at times and if they do not get what they want, they break things, or their behavior will erupt. S1 indicated that her voice can be loud, but she was not yelling, instead it was her way to emphasize the message to the clients. S1 indicated that when she speaks in a firm voice to C1-2, that she gets positive result in re-directing their behaviors. S1 also stated that she treats the clients, as well as the staff with dignity and respect. LPA interviewed S2-S5 who all denied the allegation. All of them stated that they never heard or seen S1 yell at clients. S2-S5 also indicated that they are all being treated with respect and dignity by S1 and don't have any issues. S2 indicated that S1's voice gets louder at times, but it was because the clients cannot hear her. S2 indicated that S1 had to speak louder so clients can hear and follow her. S2 stated he does not take it as S1 yelling. LPA interviewed S6 who indicated that she heard S1 yelled at clients. S6 indicated she does not like how S1 treats and handles the clients. S6 indicated that she has Administrator license too and knows the regulations. S6 stated that she left and came back to work at the facility again because S1 called and begged her to come back to work. LPA also attempted to interview three (3) clients (C1-3) but cannot communicate due to cognitive impairment. One client (C4) indicated that he did not hear or have seen S1 yell at clients. C4 indicated he is happy living in the facility. LPA reviewed client files, ID notes/Daily log notes and incident reports filed but no evidence could be found. LPA was unable to corroborate allegation.

Based on statements, record reviews and interviews conducted with staff and clients, there was not enough supportive evidence to concur with the reported allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did nor did not occur, therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of the report was provided to the Administrator, Herminia DelaCruz.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/31/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

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