197802685-11-8-2022-28-AS-TVAO-CNNPDA-20230202101312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802685
Report Date: 11/08/2022
Date Signed: 11/08/2022 01:26:06 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
11/02/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221102112731

FACILITY NAME:	MONTEREY PARK HOME		FACILITY NUMBER:	197802685
ADMINISTRATOR:	HIRAM OWEN MASAYON		FACILITY TYPE:	735
ADDRESS:	1539 FELIZ ST		TELEPHONE:	(626) 289-8701
CITY:	MONTEREY PARK	STATE: CA	ZIP CODE:	91754
CAPACITY:	6	CENSUS: 6	DATE:	11/08/2022
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Marietta Belleza, House Lead Staff		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Staff used foul language to intimidate Client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the above stated allegation. LPA met with the House Lead, Marietta Belleza, and explained the reason for the visit. The Community Services Specialist, Luisana Cruz, from Eastern Los Angeles Regional Center was also present for the investigation.

The investigation consisted of the following:
LPA Chan 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, 6 Staff, and 3 Clients. The 3 other clients were not able to communicate with LPA.

(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: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

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-20221102112731

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: 11/08/2022

NARRATIVE

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The investigation revealed the following:

Allegation – Staff used foul language to intimidate client. It is alleged that Staff #1 (S-1) used foul language to speak to Client #1 (C-1) when client questioned about an incident involving another staff. During the visit today, LPA interviewed a total of 6 Staff (S-1 through S-6) from different shifts and the Administrator. All 6 Staff denied using foul language to intimidate client. The staff interviewed have not heard any staff speaking inappropriately toward clients. They stated a firm tone of voice is used when clients do not comply, but never yell or try to intimidate them. They treat them with respect and explain to the clients when clients do things that are unacceptable. Some staff stated that C-1 has the tendency to fabricate stories. Per C-1's Regional Center IPP report, it stated that C-1 fabricates stories with the intention to get his/her way. LPA interviewed 3 Clients today. 2 out of the 3 Clients stated the staff are nice and do not use foul words when speaking with them. They also stated they feel comfortable living there.

The current Administrator stated an in-service training was conducted with all staff after C-1 informed her of this incident. The Administrator reported this alleged incident to all agencies including law enforcement as a mandated reporter. They have a zero tolerance policy which involves any forms of abuse such as physical, verbal, or emotional. The previous Administrator confirmed none of the staff at this home was given any disciplinary action due to inappropriate behaviors.

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 House Lead. 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: 11/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2022

LIC9099 (FAS) - (06/04)

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