197802527-8-26-2021-28-AS-FFIS-C79W3S-20210927165627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802527
Report Date: 08/26/2021
Date Signed: 08/26/2021 04:00:34 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200117125024

FACILITY NAME:	SCANDIA GUEST LODGE		FACILITY NUMBER:	197802527
ADMINISTRATOR:	GINA SUAREZ		FACILITY TYPE:	735
ADDRESS:	1248 E. 10TH STREET		TELEPHONE:	(562) 599-2451
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	74	CENSUS: 53	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Ericka Jimenez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff retained a resident that was a threat to other residents and staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced subsequent complaint visit for the allegation above. LPA met with administrator Ericka Jimenez and the purpose of the visit was discussed.

Initial Visit was conducted on 1/27/20 by LPA's Angelica Rea and Jose Villalobos. LPA's interviewed Client #2 - Client #9 (C2-C9), Staff #1 - Staff #2 (S1-S2) , and obtained copies of specific documents from Client #1's file. Client #1 (C1) was no longer a resident of the facility at the time of the initial visit and could not be reached via phone calls. Multiple calls were made and voicemail's left prior to conducting todays visit. On todays visit, LPA Villalobos interviewed Staff #3-Staff #4 (S3-S4).

Contined on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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-20200117125024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SCANDIA GUEST LODGE	FACILITY NUMBER: 197802527
	VISIT DATE: 08/26/2021

NARRATIVE

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The Investigation revealed the following: In regards to the allegation "Facility staff retained a resident that was a threat to other residents and staff" it was alleged that facility staff failed to remove C1 from the facility as C1 was a threat to other clients and staff. (4) of (4) staff interviewed denied the allegation. (6) of (9) clients interviewed could not corroborate the allegation. Details state that C1 assaulted other clients and kept a knife in their belongings and that S1 did not evict C1 because S1 did not like some of the other clients or staff. Interviews with staff show that C1 did not get along with C2 or C3 and they would have verbal altercations. Staff stated C1 did not get physical with other clients or ever have a knife in their possession. (3) of (9) clients stated that C1 was a threat because C1 would start verbal altercations and would try to intimidate other clients. LPA reviewed incident report dated 10/28/19 of verbal altercation between C1 and C2 and another dated 1/11/20 between C1 and C3 of another verbal altercation. Incident reports state staff intervened and contacted C1's placement agency to report incidents and also noted that there were no physical altercations. Review of C1 files shows that C1 left the facility on 1/17/20. LPA was unable to contact C1 and C1's placement agency did not return phone calls for interviews. Based on interviews and files reviewed LPA was unable to find proof that the allegation is true. 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 this allegation is unsubstantiated.

Exit Interview was conducted with Administrator Ericka Jimenez and a copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC9099 (FAS) - (06/04)

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