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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802685
Report Date: 11/01/2022
Date Signed: 11/01/2022 05:36:25 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
10/26/2022 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221026150801
FACILITY NAME:MONTEREY PARK HOMEFACILITY NUMBER:
197802685
ADMINISTRATOR:HIRAM OWEN MASAYONFACILITY TYPE:
735
ADDRESS:1539 FELIZ STTELEPHONE:
(626) 289-8701
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY:6CENSUS: 6DATE:
11/01/2022
UNANNOUNCEDTIME BEGAN:
12:38 PM
MET WITH:Joe Hernandez, StaffTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff hit client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced complaint visit regarding the above stated allegation. LPA was allowed entry by Staff, Joe Hernandez. Administrator, Jennifer Pichinte, arrived shortly and the reason for the visit was explained. Eastern Los Angeles Regional Center Service Coordinator, Yesenia Gomez, was also present for most of the visit.

The investigation consisted of the following:

LPA obtained copies of Staff roster, Client roster, and Staff In-Service Training logs. LPA reviewed Client #1’s (C-1) file and obtained copies of the Face Sheet, Annual Behavior Progress Report, and Annual Individual Program Plan (IPP). Interviews were held with the Administrator, 5 Staff, and 3 Clients. The 3 other clients are non-verbal.

(Continue on LIC9099C)
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: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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-20221026150801
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: MONTEREY PARK HOME
FACILITY NUMBER: 197802685
VISIT DATE: 11/01/2022
NARRATIVE
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The investigation revealed the following:

Allegation – Staff hit client. It is alleged that 2 Staff slapped Client #1 (C-1) in the face on 10/19/22. LPA interviewed Administrator Pichinte who was aware of the alleged incident. She stated that the law enforcement was contacted, and the case is under review. In the meantime, the 2 Staff are taken off the work schedule until the investigation is completed. During the visit today, LPA interviewed the alleged staff via telephone and they denied slapping or hitting C-1 nor have they witnessed any staff hitting a client. They stated they have been working at the home for over 10 years and would never hit a client. LPA interviewed 3 other staff and none of them have seen their coworkers physically or verbally abuse a client. LPA reviewed Staff In-Service training logs conducted this year, which included topics such as verbal and physical abuse, Mandated Reporter Policy, and Crisis Prevention Intervention Tools. C-1 confirmed that 2 Staff physically hit C-1 and indicated that C-1 was slapped in the face by one staff and hit in the back of the head by another staff. 2 out of 3 Clients stated that Staff are nice to them and had never hit them. LPA reviewed the current IPP for C-1 and it revealed that C-1 fabricates stories with the intention to get his/her way.

Based on the information gathered, there is no evidence to support 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 House Lead, Marie Belleza. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
LIC9099 (FAS) - (06/04)
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