191801893-1-12-2024-31-AS-MVAO-D223XA-20240131173802

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191801893
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:20:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/08/2024 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20240108163916

FACILITY NAME:	KINGSLEY GROUP HOME II		FACILITY NUMBER:	191801893
ADMINISTRATOR:	LORCA, ANITA		FACILITY TYPE:	735
ADDRESS:	3279 LARGA AVE.		TELEPHONE:	(323) 664-2049
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90039
CAPACITY:	10	CENSUS: 6	DATE:	01/12/2024
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Valintin "June" Dizon		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Gary Tan and Michael Cava conducted a complaint visit to the facility to investigate the above allegation. It was reported that on or around 01/05/24, facility administrator, spanked Resident 1 (R1). There were no witnesses identified to this allegation. Today's investigation consisted of interviews with residents and staff, record review, and a physical plant inspection to insure the health and safety of the residents.

At apprximately 11:45am, two (2) of two (2) staff were interviewed, and they denied witnessing administrator spanking R1, or being inappropriate to any other residents. Interviews made with six (6) of six (6) residents. Four (4) of the six residents, including R1, are non-verbal and unable to communicate their needs. Because R1 is non-verbal, they could not identify any witnesses or confirm the allegation. Two (2) of the six residents expressed no complaints or concerns about mistreatment from the administrator or staff. Based on the information obtained, there was insufficient evidence to prove that staff hit R1. Therefore, the allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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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