197609040-1-25-2023-28-AS-RORN-CNTQE6-20230207110545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609040
Report Date: 01/25/2023
Date Signed: 01/25/2023 01:16:03 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/19/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230119155348

FACILITY NAME:	BLUE EAGLE VILLAS 2		FACILITY NUMBER:	197609040
ADMINISTRATOR:	ANGELES, GIOVANI		FACILITY TYPE:	735
ADDRESS:	203 N KINGSLEY DRIVE		TELEPHONE:	(951) 378-5150
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY:	6	CENSUS: 6	DATE:	01/25/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Giovani Angeles		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff physically abused a client while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Giovani Angeles and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Giovani Angeles, Staff 1-2, and Client 1-2 (C1-2) and attempted to interview C3-6. LPA additionally conducted a telephone interview with Frank D Lanterman Regional Center Service Coordinator (SC) Thrawlynne Lopez and S3. LPA obtained copies of Staff and Client Rosters. LPA reviewed C1-3's file and collected copies of documents relevant to the investigation.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

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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Control Number 28-AS-20230119155348

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BLUE EAGLE VILLAS 2	FACILITY NUMBER: 197609040
	VISIT DATE: 01/25/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff physically abused a client while in care, it is alleged that a facility client witnessed a facility staff physically abuse another facility client. Interviews conducted with Administrator and S1-3 revealed that there has not been any incident at the facility in which a facility staff physically abused or hurt any facility client. Interviews with facility staff revealed that all facility staff treat all clients with dignity and respect and staff have never physically or verbally abused any client in care. Interview conducted with Frank D Lanterman Regional Center SC revealed that their investigation did not reveal anything of concern and stated that C1 has had behaviors such fabricating stories at their previous placement. Interviews conducted with 1 out of 2 facility clients revealed that they observed S1 tap C2 on the behind in a teasing manner and they felt that S1 did that to make fun of them as they believe that S1 was overhearing the phone conversation C1 was having on the phone while in their room. 1 out of 2 clients stated that facility staff have never physically hurt them and they stated that staff are nice and take good care of them. LPA attempted to interview C3-6 but was not able to properly interview them as they are non-verbal clients.

During the time of the visit, LPA observed clients in their rooms and in the living room watching television and did not observe anything of concern. LPA observed facility staff tending to the clients and assisting them and did not observe anything of concern with staff and client interactions. Based on statements gathered from interviews conducted with staff, Frank D Lanterman Regional Center staff, facility clients and LPA observations, 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. A copy of the report was provided to Administrator Giovani Angeles.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023

LIC9099 (FAS) - (06/04)

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