197606893-10-25-2022-28-AS-MVAO-CL6VAU-20221114151631

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197606893
Report Date: 10/25/2022
Date Signed: 10/25/2022 12:29:05 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, 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
07/20/2020 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200720120325

FACILITY NAME:	TIFFANY'S BOARD AND CARE IV		FACILITY NUMBER:	197606893
ADMINISTRATOR:	COSTANCE EDWARDS		FACILITY TYPE:	740
ADDRESS:	16955 JANINE DRIVE		TELEPHONE:	(562) 690-9274
CITY:	WHITTIER	STATE: CA	ZIP CODE:	90603
CAPACITY:	6	CENSUS: 4	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	House Lead - Caregiver - Armando Salvador		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are financially abusing resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ashley Calderon conducted unannounced subsequent visit to the facility to further investigate the above allegation. LPA Calderon met with Armando Salvador and explained the purpose of today’s visit.

On 7/29/20 LPA Villalobos conducted an initial complaint via telephonically. LPA interviewed the following: Administrator Tiffany Sasada , staff #1 (S1), staff #2 (S2), staff #3 (S3). LPA was unable to interview (3) of (3) residents in care due to their cognitive ability. LPA toured the facility, collected copies of staff and client roster.

On 10/25/22, visit to the facility the complaint investigation consisted of LPA Calderon toured the facility physical plant, attempt and interviews residents, interviewed staff who were present. Interviewed Administrator via telephonically and gathered supportive document from Chase Bank fraudent team and Branch Manager that was provided to LPA Villalobos. Continuation on 9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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 2

Control Number 28-AS-20200720120325

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: TIFFANY'S BOARD AND CARE IV	FACILITY NUMBER: 197606893
	VISIT DATE: 10/25/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding allegation: Facility staff are financially abusing resident. LPA Calderon interviewed 3 out of 3 staff. LPA Calderon asked S4 and S5 "Does this facility handle P&I's of the residents? S4 stated " No families handle their fiances." S5 stated " no we don't" . In the interviews S3 and S4 both stated no issues on financial abuse towards residents. LPA Calderon attempt to visit 3 out of 4 residents were attempt interviews due to cognitive ability. 1 resident during the interview stated "No issues financially and no issues with the facility. LPA Calderon reviewed supportive document given to Administrator TIffany Elisaldez by Chase Bank.

Documentation by Chase Bank stated:

" On 5/30/2020, you filed claim with JP Morgan Chase Bank for an unauthorized online remote deposit of a $5,000 check that took place on 5/27/2020 that were posted to your bank account."
"On 5/27/2020 our fraud team issued a comment on your account that your online banking log in credentials were potentially compromised. "
On 6/4/2020 the check references above was returned unpaid.

Based on the interviews with residents and staffs and reviewing documentation gathered, 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.

An exit interview was held with House Lead Armando Salvador, and a copy of this report was provided and a copy of the appeal rights were given.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2