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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 08/28/2024
Date Signed: 08/28/2024 02:05:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/20/2024 and conducted by Evaluator Elvira Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240820093935
FACILITY NAME:BAY BREEZE CAREFACILITY NUMBER:
191600093
ADMINISTRATOR:MEJIA, JEMIMAHFACILITY TYPE:
735
ADDRESS:1653- 55 SANTA FE AVETELEPHONE:
(562) 432-8033
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:76CENSUS: 63DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Kristine Angeles-Facility CoordinatorTIME COMPLETED:
02:16 PM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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On 08/28/24 Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced complaint investigation regarding the allegation listed above. LPA met with Administrator, Jemimah Mejia, and the purpose of the visit was explained.

The investigation consisted of the following:

LPA received facility records which consisted of Staff Roster, Client Roster, House Rules, C1 records, including Physician’s Report, Admission Agreement, Identification and Emergency Information (LIC 601), Resident Appraisal (LIC603), Unusual Incident Reports, and a copy of the Eviction Notice (dated 08/19/24). Interviews conducted with client #1 (C1) and staff #1 (S1). Furthermore, LPA and Facilities Coordinator conducted a tour of the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 2
Control Number 11-AS-20240820093935
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BAY BREEZE CARE
FACILITY NUMBER: 191600093
VISIT DATE: 08/28/2024
NARRATIVE
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The investigation revealed the following:

Regarding the allegation “Illegal eviction,” it is alleged that client received an eviction letter on 08/19/24. Records reviewed revealed, that C1 received a 30-day Eviction Notice on 08/19/24 and refused to sign it. Unusual Incident Reports revealed that C1 has a history of aggression and physical violence towards clients, and staff members, dating from November 2023 to August 2024. LPA interviewed C1 via telephone and revealed that they were provided an Eviction Notice due to aggression. C1 stated they have had problems with clients at the facility in the past, but they have worked out their issues. An interview conducted with Administrator Jemimah Mejia revealed that the facility has been having on-going issues with C1. Administrator Jemimah Mejia stated that C1 can be very aggressive towards clients and staff. Furthermore, a 30-day Eviction Notice for C1 was faxed to Community Care Licensing on 07/24/24, following the California Code of Regulations, Title 22.

Based on LPA records reviewed and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2