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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191592599
Report Date: 08/12/2022
Date Signed: 08/12/2022 02:02:59 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, 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
08/09/2022 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20220809082009
FACILITY NAME:FOUNDERS HOUSE OF HOPEFACILITY NUMBER:
191592599
ADMINISTRATOR:CRYSEL SANTOSFACILITY TYPE:
735
ADDRESS:18025 PIONEER AVE.TELEPHONE:
(562) 860-3351
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:98CENSUS: 75DATE:
08/12/2022
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Marhlyn Sapugay Assistance AdministratorTIME COMPLETED:
02:16 PM
ALLEGATION(S):
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Resident bathroom is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with the Assistance Administrator Marhlyn Sapugay and Administrator, Crysel Santos, to explain the purpose of the visit.
LPA toured the facility with the Assistant Administrator and inspected rooms #3 #5, #26, #16, #17 #47, #49, #48, #40, and #42, LPA obtained copies of the staff roster, client roster, and recent maintenance request form dated 7/24/2022

The investigation revealed the following:
Allegation – Resident bathroom is in disrepair
During the visit today, LPA observed the maintenance man repairing some toilets as LPA inspected rooms. In room #5 and #42 the toilet flush handle was loose and dangling over the face of the toilet. In room 26, the toilet was missing the cover and in room 16, it was reported that toilet malfunctioned, sometimes flushing and sometimes not.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/09/2022 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20220809082009

FACILITY NAME:FOUNDERS HOUSE OF HOPEFACILITY NUMBER:
191592599
ADMINISTRATOR:CRYSEL SANTOSFACILITY TYPE:
735
ADDRESS:18025 PIONEER AVE.TELEPHONE:
(562) 860-3351
CITY:ARTESIASTATE: CAZIP CODE:
90701
CAPACITY:98CENSUS: DATE:
08/12/2022
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:TIME COMPLETED:
02:16 PM
ALLEGATION(S):
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Resident room is not regularly cleaned
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alberto Lopez conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with the Assistance Administrato Marhlyn Sapugay and Administrator, Crysel Santos, to explain the purpose of the visit.

LPA toured the facility with the Assistant Administrator and inspected rooms #3 #5, #26, #16, #17 #47, #49, #48, #40, #42 and common areas. LPA obtained copies of the staff roster, client roster, and maintenance request log dated 07/24/22

The investigation revealed the following:
Allegations – Facility is not cleaned regularly
During the visit today, LPA observed the housekeeper and janitor cleaning the rooms and hallways. The Administrator and Assistance Administrator stated they try their best to keep the facility as clean as they could and even help out themselves.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20220809082009
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
VISIT DATE: 08/12/2022
NARRATIVE
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The clients’ rooms are tidied up daily. The floors are mopped, trash is picked up, and sheets are changed weekly. Based on interviews with the clients, they stated the staff do a good job keeping the facility and their rooms clean. LPA observed the facility to be clean and well maintained.

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



An exit interview was conducted with the Assistant Administrator. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20220809082009
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
VISIT DATE: 08/12/2022
NARRATIVE
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Assistance Administrator and Administrator stated that all toilets are repaired as soon as it is reported to them by the clients. Administrator had maintenance man replace toilet in room 16 during visit. Also, the other restrooms in disrepair were repaired and LPA verified through 2nd walk through.

Based on LPA observations and interview with staff and clients, the preponderance of evidence standard has been met, therefore the allegation above is found to be SUBSTANTIATED

An exit interview was conducted with the Assistant Administrator. A copy of this report along with the appeal rights were provided
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20220809082009
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: FOUNDERS HOUSE OF HOPE
FACILITY NUMBER: 191592599
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2022
Section Cited
CCR
80087(c)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is met as evidenced by:
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Licensee will repair the toliet handles in room #5 and # 42 and obtain cover for toilet in room #26. Will replace toliet in room #16 and send proof to LPA by POC DATE.

****Was taken care of at time of visit, no further action required.****
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LPA observed toilet flush handle in room #5 and #42 to be dangling from toilet face. Also, toilet in room #16 is reported to sometimes flush and sometimes it doesn’t. Room #26 had no toliet cover on water reservior.
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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.
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5