191290706-7-6-2023-31-AS-EMIR-CUWVQX-20230821163904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290706
Report Date: 07/06/2023
Date Signed: 07/06/2023 02:32:15 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, 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-20230705122449

FACILITY NAME:	HAMILTON HOUSE		FACILITY NUMBER:	191290706
ADMINISTRATOR:	PETERSON, JANICE		FACILITY TYPE:	735
ADDRESS:	739 W. GLENOAKS BLVD.		TELEPHONE:	(818) 502-9188
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91202
CAPACITY:	11	CENSUS: 9	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Carlos Correa, Kathy Solorzano		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff retaliated against resident for reporting pests at the facility.
Staff gave resident their P & I money payment late.
Staff did not give resident the correct amount of P & I money.
Staff yelled at resident.
Staff did not provide resident a place to live while treating for bed bugs at the facility.

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, Carlos Correa arrived shortly after. Today's investigation consisted of interviews with residents and staff between 9:15am to 11:00am. LPA conducted a record review between 11:30am to 12:30pm. Between 12:30pm-1:30pm, a physical plant inspection was made to insure the health and safety of the residents in care.

Staff retaliated against resident for reporting pests at the facility/Staff gave resident their P & I money payment late/Staff did not give resident the correct amount of P & I money:
These allegations were addressed In conjuction to complaint control #31-AS-20230626162028. It was alleged that because Resident 1 (R1) reported an infestation of bed bugs and rodents, the administrator has been retaliating towards R1 by distributing their P&I checks late, and forcing R1 to get up at 8am every

Unsubstantiated

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)

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Control Number 31-AS-20230705122449

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
	VISIT DATE: 07/06/2023

NARRATIVE

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morning to take care of their hygiene needs, which is earlier than the other residents. Interviews with staff and residents did not corroborate with the allegation. The facility is a level II home where residents are independent enough to get up on their own and conduct their own hygiene and personal needs with minimal to no prompting. R1 is independent and able to care for self with some occasional reminders. In regards to R1's P&I check, funds are received from Regional Center through mail between the 12th and 17th of each month. Interview with residents deny them getting their checks late. Review of the Resident Fund Records indicate that checks are received anywhere between the 12th and 17th of every month. No other discrepancies observed. Based on the information obtained, there was insufficient evidence to prove that staff retaliated against the resident in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff yelled at resident:
In regards to the allegation, it was alleged that R1 was yelled at because the administrator was not invited to a Regional Center meeting. No witnesses identified to the allegation. Nor was there a place, date and time given. Interviews with staff and residents could not confirm that R1 was yelled at by the administrator. Based on the information obtained, there wasn't enough evidence to prove that the administrator yelled at R1. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not provide resident a place to live while treating for bed bugs at the facility:
In regards to the allegation, it's being alleged that residents weren't provided a place to stay while the facility was being sprayed for bed bugs. Interviews with staff and residents do not corroborate with the allegation. Residents went on an outing or attended their own activities while the facility was being serviced for bed bugs. According to the administrator, it took about four hours for the facility to receive the treatment for bed bugs. Resident rooms and belongings were disinfected. After the treatment, residents were allowed to return to the home. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

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

LIC9099 (FAS) - (06/04)

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