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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592503
Report Date: 02/06/2023
Date Signed: 02/06/2023 01:30:49 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
01/31/2023 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230131162007
FACILITY NAME:CASA COLINA TRANSITIONAL LIVING CENTERFACILITY NUMBER:
191592503
ADMINISTRATOR:STEPHANIE KAPLANFACILITY TYPE:
735
ADDRESS:250 E. HARRISONTELEPHONE:
(909) 596-7733
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:42CENSUS: 39DATE:
02/06/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Stephanie Kaplan (Executive Director of Transition Program and Rehab Services)/S-1TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Lack of care and supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Elizabeth Irra and Tena Herrera conducted the initial 10-day complaint visit to investigate the above allegation. LPA met with Stephanie Kaplan (Executive Director of Transition Program and Rehab Services)/S-1 and discussed the purpose of today's visit.

During today's visit, LPAs obtained a copy of the staff and client rosters, copy of Casa Colina TLC-Privelege Plan and copy of Casa Colina Transitional Living Center Rules. LPAs also reviewed client files for Client #1 through Client #4 (C-1 through C-4) and obtained relevant documentation. LPAs interviewed Staff #1 through Staff #4 (S-1 through S-4). LPAs also interviewed Client #2 through Client #4 (C-2 through C-4). LPA was unable to interview Client #1 (C-1) as C-1 was at a doctor's appointment and LPA left voice mail messages for a return call.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
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 28-AS-20230131162007
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: CASA COLINA TRANSITIONAL LIVING CENTER
FACILITY NUMBER: 191592503
VISIT DATE: 02/06/2023
NARRATIVE
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Allegation: Lack of care and supervision: Staff interviews revealed that there are approximately (5) to (6) clients that are able to go out in the community on their own/unsupervised. Per staff interviews, those clients have clearance from their physician to be unsupervised in the community. Staff interviews revealed that clients must sign-out and sign-in with staff and that the outing is no more than (2) hours long. Per Staff interviews there is (1) client that drives and keeps their car on premises. Staff interviews revealed the (1) client that drives must undergo the sign-in and sign-out process at the nurses station as the car keys must be signed out and signed back in. Staff interviews revealed that the local thrift stores are within walking distance from this facility. Staff indicated there are not staffing concerns. Client interviews revealed that they are able to sign-out and sign-in to go out on the community on their own. Interviewed clients indicated they are able to be out in the community unsupervised for (1) to (2) hours. Interviewed Clients indicated there are no staffing issues. Staff and Client interviews and documentation collected do not corroborate this allegation.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, copy of report and Appeal Rights were provided to Stephanie Kaplan.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC9099 (FAS) - (06/04)
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