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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290706
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:28:48 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Michael Cava
COMPLAINT CONTROL NUMBER: 31-AS-20230705102034
FACILITY NAME:HAMILTON HOUSEFACILITY NUMBER:
191290706
ADMINISTRATOR:PETERSON, JANICEFACILITY TYPE:
735
ADDRESS:739 W. GLENOAKS BLVD.TELEPHONE:
(818) 502-9188
CITY:GLENDALESTATE: CAZIP CODE:
91202
CAPACITY:11CENSUS: 9DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Carlos Correa, Kathy SolorzanoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPA met with staff, Kathy Solorzano and advised her of the complaint. The administrator, Caros Correa, arrived shortly after. It was reported that while the facility was being treated for pest control, Resident 1's (R1) belongings were kept in the driveway or outside in the open. When it rained, R1's belongings got soaked because the bags that R1's belongings were being kept in were not tied up or sealed properly, causing damage. Today's investigation consisted of interviews with residents and staff between 9:15am to 11:00am. A record review was conducted between 11:30am-12:30pm. A physical plant inspection was made between 12:30pm-1:30pm. During the course of the investigation, interviews revealed that R1's belongings were kept outside during the facility's treatment of pests. It was also revealed that R1's belongings were not sealed or tied properly in bags, preventing it from getting damage. When the LPA questioned why R1's belongings weren't safeguarded properly to prevent damage, it could not be confirmed. Based on the information obtained, the above allegation is Substantiated. Citation issued on the 9099D. Appeal rights and a copy of this report given.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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 31-AS-20230705102034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: HAMILTON HOUSE
FACILITY NUMBER: 191290706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/13/2023
Section Cited
HSC
80026(d)
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Safeguards for Cash Resources, Personal Property, and Valuables of Residents: Cash resources, personal property, and valuables of clients handled by the licensee shall be free from any liability the licensee incurs.
This requirement was not met as evidenced by: During the course of the investigation,
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As POC, the administrator will hold staff training to address this section of the regulations. As proof training was completed, the administrator will submit a copy of their training topic addressing this section of the regulations and attendance log to the licensing agency by 07/13/23.
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it was confirned through interviews that R1's personal belongings was not tied and sealed properly to prevent from any damages from the rain and or heat.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
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