197801344-3-14-2024-28-AS-RORN-D3HN4Z-20240319100847

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801344
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:22:43 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
05/05/2023 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230505083441

FACILITY NAME:	VICTORIA HOME		FACILITY NUMBER:	197801344
ADMINISTRATOR:	MARIA ALVARADO		FACILITY TYPE:	735
ADDRESS:	14002 MANSA DRIVE		TELEPHONE:	(562) 921-0543
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	4	CENSUS: 3	DATE:	03/14/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maria Alvarado		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff hit client in care
Staff mismanaged client's funds
Staff did not properly maintain client records
Staff did not treat client with dignity
Staff humiliated client

INVESTIGATION FINDINGS:

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

The investigation consisted of: On 5/09/23, LPA conducted an interview with Administrator Maria Alvarado, and S1. LPA conducted a phone call with ELARC SC Christian Mejia and with C1 FM. LPA reviewed C1-3 client files and collected copies of documents relevant to the investigation. LPA reviewed C1-3's Records of Client's/ Resident's Safeguarded Cash Resources (LIC405) and collected copies of records for C1-3. LPA conducted a tour of facility dining room, living room, kitchen, bathroom and client rooms. LPA also collected contact information for S2. LPA additionally conducted a collateral visit to Pen Homes, Inc, which is

(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: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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 4

Control Number 28-AS-20230505083441

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: VICTORIA HOME	FACILITY NUMBER: 197801344
	VISIT DATE: 03/14/2024

NARRATIVE

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a Community Based Day Program, and conducted interviews with C1-3 and Pen Homes, Inc, Program Director Salomon Wupuy and Day Program DP S1-2. On 3/14/24, LPA conducted an interview with ELARC SC Christian Mejia, S2 and collected copies of staff and client rosters.

Investigation revealed the following: Regarding allegation, Staff hit client in care, it is alleged that a facility staff hits C1 on their arm when they soil themselves. Interviews with facility staff revealed that facility staff never hit any client in care when they soil themselves or for any other reason. Staff stated that all clients are always treated with dignity and respect. LPA interviewed a total of 3 clients, and all 3 clients stated that staff do not hit them. They stated that they like the home, they feel safe and they do not have any concerns. 1 out of the 3 clients stated that their family member wants to move them out of the home but they do not want to move. LPA interviewed ELARC SC Christian Mejia who stated that he has not received any complaints from any facility client that they are being hit by a staff at the facility. LPA toured the facility and observed 3 clients, 2 clients were in their rooms and 1 client was in the living room. LPA observed all clients and they all appeared comfortable and LPA did not observe any bruising on any client and did not observe anything of concern. Based on statements gathered from interviews conducted with staff, clients and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff mismanaged client's funds, it is alleged the facility is misappropriating client funds and that C1 did not have money to buy shoes and pay for two identification cards. C1 had not been at the facility from 03/10/23 - 04/18/23 and should have Personal & Incidental (P&I) monies available for use. After review of C1’s P&I ledger and receipts, it was noted that funds for March and April 2023 were available to C1 as well as balance from monies not spent by C1 while client was not in the facility. P&I ledger lists deposits from monthly P&I as well as P&I from the day program. LPA observed that C1 requests/ receives money frequently. P&I funds were found to have been spent on food purchases, payment for camp, haircuts, shopping and client request for cash to take to day program. Interviews conducted with 3 staff revealed that the Administrator handles P&I for the clients and their money is only spent on what the clients want and/or need. Per Administrator and ELARC SC, the vacation fund was approved by the placement agency as well as C1's FM. C1 FM stated that they believed the camping trip had been paid in full. Administrator stated that the camping trip was not paid in full and that C1 FM as well as ELARC SC were aware that the trip would be paid in installments until paid off. ELARC SC stated that the placement agency was aware that the camping trip was being paid in installments and stated that they do not have any concerns regarding any clients P&I

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230505083441

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: VICTORIA HOME	FACILITY NUMBER: 197801344
	VISIT DATE: 03/14/2024

NARRATIVE

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funds. LPA reviewed C1's P&I ledgers from 12/13/21 - 05/09/23, and no discrepancies or issues were found. LPA additionally reviewed C2-3's P&I ledgers, and no discrepancies or issues were found. Interviews conducted with 3 out of 3 clients could not corroborate the allegation. Based on statements gathered from interviews conducted with staff, clients, ELARC SC and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff did not properly maintain client records, it is alleged facility staff did not have C1's P&I records from 2022 specifically prior to August 2022. Facility staff allegedly could not provide any records for 2021 -2022 and only had records for 2020 and threatened to evict C1 due to request for records. Interview conducted with Administrator revealed that all client P&I records are kept current at all times. Administrator stated that she never stated that she only had C1's 2020 P&I Ledgers. She stated that she did not threaten to evict C1 or any other client but she did write a letter to ELARC SC regarding C1 needing a higher level of care. ELARC SC stated that the placement agency has no concerns regarding the facility not properly maintaining client records. LPA requested and reviewed C1's P&I Ledgers from 12/13/21 - 05/09/23, and no discrepancies or issues were found. LPA additionally reviewed C2-3's P&I ledgers, and no discrepancies or issues were found. LPA observed that facility properly maintains client records. Based on statements gathered from interviews conducted with staff, ELARC SC and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

For allegations, Staff did not treat client with dignity and Staff humiliated client, it is alleged that facility staff argues with clients, C1 does not feel comfortable living under the care of the administrator, facility administrator and S1 allegedly made fun of C1's body part and C1's shoes were severely torn and could be a trip hazard. Interviews conducted with facility staff revealed that all facility clients are treated with dignity and respect at all times and Administrator and S1 denied ever humiliating C1 or any other facility client. They denied ever making fun of any client. Staff stated that all clients are treated like family. Staff stated that C1's shoes are not torn and stated that C1's shoes are not a trip hazard. Interviews conducted with Day Program Director and DP S1-2 revealed that they have not observed staff at facility humiliate clients when they arrive at facility for pick up or drop off. They stated that they have observed staff to treat clients with dignity and respect. They also stated that all clients attend the day program and that they are always well dressed and none of their shoes are torn to the point of being considered trip hazards. Interviews conducted with 3 out of 3 clients revealed that they like living at the facility, staff treat them with dignity and respect and they have not

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230505083441

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: VICTORIA HOME	FACILITY NUMBER: 197801344
	VISIT DATE: 03/14/2024

NARRATIVE

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been humiliated by staff. 1 out of 3 clients stated that they are happy at facility, and feel comfortable at the facility but their family member wants to move them to another facility. During the visits conducted on 5/9/23 and 3/14/24, LPA observed staff interacting with clients and did not observe anything of concern. The interactions were observed to be respectful. LPA also inspected all client rooms and observed their shoes and did not observe any shoes that were severely torn to the point of being considered a trip hazard. LPA observed the shoes that clients were wearing as well as other shoes in their rooms and they all appeared well kept. Based on statements gathered from interviews conducted with staff, day program staff, clients and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Administrator Maria Alvarado.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

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