191501668-10-21-2022-28-AS-MVAO-CKJSPX-20221025140351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191501668
Report Date: 10/21/2022
Date Signed: 10/21/2022 03:54:01 PM

Substantiated

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
05/03/2021 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210503103907

FACILITY NAME:	BRITISH HOME IN CALIFORNIA LTD, THE		FACILITY NUMBER:	191501668
ADMINISTRATOR:	MARLENE RAINEN		FACILITY TYPE:	741
ADDRESS:	647 MANZANITA AVE		TELEPHONE:	(626) 355-7240
CITY:	SIERRA MADRE	STATE: CA	ZIP CODE:	91024
CAPACITY:	41	CENSUS:	DATE:	10/21/2022
		UNANNOUNCED	TIME BEGAN:	03:32 PM
MET WITH:	Executive Director, Marlene Rainen		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff member did not allow residents access to Ombudsman services.

INVESTIGATION FINDINGS:

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**********This supersedes the report dated 09/07/2022. The report was superseded to correct initial visit date listed on the 1st page.**********

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation and deliver findings for the allegation listed above. Upon arrival, LPA met with Executive Director, Marlene Rainen and explained the purpose of today’s visit.
During the initial visit conducted telephonically (due to Covid-19) on 5/06/2021, LPA Elizabeth Irra requested the Administrator (via email) to provide the following documents:
• Staff Roster (with contact phone numbers)
• Resident Roster (with contact phone numbers)
• Visitors Policy for March 2021 to current
• Visitors log/sign-in sheet(s) for March 2021 to current
• Staff schedule for March 2021 to current

During today’s visit, LPA Pena interviewed the following: Two (2) Staff, Staff #1 (S1), Staff #2 (S2), (1) Witness, Witness #1 (W1), the Executive Director/Administrator (A1) and obtained a copy of the Visitor's log for March 2021.

Continued on LIC 9099-C……………..

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette Pena	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022

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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