191593145-5-12-2022-28-AS-SCOL-CF8PFG-20220609111643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191593145
Report Date: 05/12/2022
Date Signed: 05/12/2022 11:19:40 AM

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
12/27/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211227113845

FACILITY NAME:	RAMONA GUEST HOME - BELLFLOWER		FACILITY NUMBER:	191593145
ADMINISTRATOR:	KANIEL, STANLEY		FACILITY TYPE:	735
ADDRESS:	9555 RAMONA ST		TELEPHONE:	(562) 867-1002
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	29	CENSUS: 22	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Stanley Kaniel; Administrator		TIME COMPLETED:	11:23 AM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted a follow up complaint investigation regarding the allegation listed above. LPA met with Stanley Kaniel and explained the reason for the visit.

The investigation revealed the following: during the initial visit conducted on 01/05/22, LPA Flores conducted a tour of the facility. LPA Flores observed rooms with missing and broken windows. Parking lot and backyard outdoor area had broken chairs, drawers, and seat cushions. Photographs were taken during the visit. During today's visit LPA interviewed the Administrator, toured the facility, and interviewed Client #1 (C1) - Client #8 (C8).

The investigation revealed the following: in regards to the allegation "facility is in disrepair", it is alleged that one of the client bedroom windows is broken which poses a safety hazard. During interview with Administrator, it was revealed that the broken window was replaced shortly after the visit completed by LPA Flores on 01/05/22. During tour of the facility, LPA observed broken window in room # 4 was replaced. Items and trash observed in the backyard outdoor area during the 01/05/22 visit were also discarded. (CONTINUED ON 9099C)

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

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

Control Number 28-AS-20211227113845

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: RAMONA GUEST HOME - BELLFLOWER	FACILITY NUMBER: 191593145
	VISIT DATE: 05/12/2022

NARRATIVE

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Interviews with clients indicated that facility staff will maintain the facility free of debris and trash.

Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview held, and a copy of this report along with appeal rights was provided.

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

Page: 2 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
12/27/2021 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211227113845

FACILITY NAME:	RAMONA GUEST HOME - BELLFLOWER		FACILITY NUMBER:	191593145
ADMINISTRATOR:	KANIEL, STANLEY		FACILITY TYPE:	735
ADDRESS:	9555 RAMONA ST		TELEPHONE:	(562) 867-1002
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	29	CENSUS: 22	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator; Stanley Kaniel		TIME COMPLETED:	11:23 AM

ALLEGATION(S):

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Residents rooms are unkempt.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted a follow up complaint investigation regarding the allegation listed above. LPA met with Stanley Kaniel and explained the reason for the visit.

The investigation revealed the following: during the initial visit conducted on 01/05/22, LPA Flores conducted a tour of the facility. During today's visit, LPA interviewed the Administrator, toured the facility, and interviewed Client #1 (C1) - Client #8 (C8).

The investigation revealed the following: in regards to the allegation "residents rooms are unkempt", it is alleged that facility staff is not assisting residents with cleaning their rooms. No other details provided. LPA toured a random sample of client rooms and observed rooms to be clean. Administrator indicated rooms are cleaned 4 times a week.

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 28-AS-20211227113845

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: RAMONA GUEST HOME - BELLFLOWER	FACILITY NUMBER: 191593145
	VISIT DATE: 05/12/2022

NARRATIVE

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All clients interviewed indicated to be happy with the services they receive here. All clients interviewed indicated housekeeping staff will assist them with cleaning their rooms and bathrooms multiple times a week. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 28-AS-20211227113845

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: RAMONA GUEST HOME - BELLFLOWER	FACILITY NUMBER: 191593145
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/26/2022 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	(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 not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator to ensure facility is clean, safe, sanitary, and in good repair at all times. Licensee/Administrator to discard all trash and debris and replace any other broken windows by POC due date.
	8 9 10 11 12 13 14	During physical plant tour conducted on 01/05/22 LPA Flores observed broken bedroom window in room #4. This poses a potential health, safety, and/or personal rights risk to the clients in care. During today's visit, LPA observed broken window had been replaced.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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