197801279-4-25-2025-28-AS-FFIS-DGF2GK-20250506172315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801279
Report Date: 04/25/2025
Date Signed: 04/25/2025 06:06:07 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
04/21/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250421114238

FACILITY NAME:	LEANING PINE, THE		FACILITY NUMBER:	197801279
ADMINISTRATOR:	VILLAFLOR, ELNA C.		FACILITY TYPE:	740
ADDRESS:	1809 LEANING PINE DRIVE		TELEPHONE:	(909) 396-4675
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 5	DATE:	04/25/2025
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Elna Villaflor, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility did not have staff screened for Tuberculosis.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced and met with Administrator, Elna Villaflor. The reason for the visit was explained.

During the visit today, LPA toured the facility and obtained copies of the client and staff rosters. LPA also reviewed personnel files and interviewed the administrator, 2 Staff, and 2 Residents.

Allegation - Facility did not have staff screened for Tuberculosis. It is alleged that a volunteer and another staff did not have a TB clearance or receive TB testing. LPA interviewed the administrator and two Staff. Administrator Villaflor stated that the volunteer in question only worked briefly at their other facility, named Banner Ridge Country Home, sometime in November of 2024, but not at this facility. She stated that all the staff are required to have a health screening and TB testing when they are hired.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

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-20250421114238

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: LEANING PINE, THE	FACILITY NUMBER: 197801279
	VISIT DATE: 04/25/2025

NARRATIVE

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LPA interviewed two other staff, and both stated they had gotten a health screening and TB test results when they were hired at the facility. One of the staff and residents interviewed confirmed the volunteer in question did not work at the facility. LPA reviewed current personnel files and observed TB test results and/or chest x-ray at the time of hire.
Based on the information gathered, there is insufficient evidence to prove this 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.

An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

LIC9099 (FAS) - (06/04)

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