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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197803548
Report Date: 12/09/2025
Date Signed: 12/09/2025 03:38:36 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/08/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251208083210
FACILITY NAME:CHEN'S HOME, INC.FACILITY NUMBER:
197803548
ADMINISTRATOR:CHEN, MARGARETFACILITY TYPE:
735
ADDRESS:5801 ALESSANDRO AVENUETELEPHONE:
(626) 456-0764
CITY:TEMPLE CITYSTATE: CAZIP CODE:
91780
CAPACITY:4CENSUS: DATE:
12/09/2025
UNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Margaret Chen, AdministratorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff does not ensure resident's behavioral needs are being met.
Licensee does not ensure staff are adequately trained.
Staff do not accord residents privacy due to surveillance at home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the allegations listed above. The purpose of the visit was explained to Administrator Margaret Chen and telephonically to DSP Tony Chan. NOTE: LPA called the facility landline and mobile # and knocked at the door upon arrival but there was no answer. Licensee/Administrator was in the home and gave access to LPA after DSP Tony Chan contacted Administrator. Inspection Authority regulation was reviewed.

The investigation consisted of: A physical plant tour of the home was conducted. A total of 2 staff were interviewed. Due to limited verbal ability or cognitive impairment residents were not interviewed. Staff and resident files were reviewed. Copies of LIC 500 Personnel Report and LIC 9020 Register of Facility were obtained. The Regional Center Corrective Action Plan (CAP) was obtained.


*Report continues next page.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
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 5
Control Number 28-AS-20251208083210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
VISIT DATE: 12/09/2025
NARRATIVE
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Allegation: Staff does not ensure resident's behavioral needs are being met. The complaint alleges the Licensee/Administrator has not hired a behavior consultant to provide consultant hours to residents as required per Department of Developmental Services (DDS) facility level change. According to information obtained, a change in service level was approved by DDS effective April 1, 2024, and licensee was issued formal level change notification on August 23, 2024. Administrator stated that the facility was previously a level 2 home, and is now a level 4C. Licensee stated that they did not hire a behavior consultant because they did not know where to find a consultant. Administrator stated they tried to get referral assistance from the Regional Center, but the Regional Center was not helpful and told licensee it would be a conflict of interest. Therefore, the licensee did not hire the behavior consultant. Administrator added that all residents have resided in the home for over 20 years, and it is the belief of Administrator that their behaviors cannot be modified because they are non-verbal. On December 5, 2025, the Regional Center issued a Corrective Action Plan (CAP). A level 4C facility is required to have 8 hours of behavior consultant services per resident semi-annually. Based on record review, the findings indicate all four residents have never obtained behavior consultation services.

Allegation: Licensee does not ensure staff are adequately trained. It is alleged there is a lack of records to demonstrate that staff received on-site orientation, continuous on-the-job training and continuing education units. Licensee stated the facility is owner operator with two live-in staff. There are total of 4 staff that provide care and supervision. Administrator stated that staff receive 1 hour of staff training per month, but they have not had time to document the training. Administrator acknowledged record keeping negligence and records disorganization. Based on record review, staff files did not contain proof of staff training. The CAP report findings state none of the staff files had proof of staff training with required continuing education units and on-the-job training requirements.


*Report continues next page.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20251208083210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
VISIT DATE: 12/09/2025
NARRATIVE
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Allegation: Staff do not accord residents privacy due to surveillance at home. According to information obtained, the Licensee/Administrator installed indoor and outdoor Ring surveillance cameras in May 2025 but did not notify the Regional Center or Department of Social Services Community Care Licensing Division (CCLD), nor obtained consent forms from the residents and families prior to installation of the cameras. Administrator confirmed they installed the cameras in May 2025 without approval from the Regional Center or CCLD. The Administrator stated they did not know the installation of cameras required approval, updated plan of operation requirements, or consent forms. Based on physical plant inspection, a total of four (4) indoor Ring cameras and one (1) Ring doorbell camera were observed. The cameras have an activated audio and motion sensor component. CCLD Guidelines for Video Surveillance state "Under no circumstances may video surveillance in facilities use an audio component." CCLD requires licensee's submit a written request that includes the surveillance plan, access to video, consent forms, updated plan of operation and facility sketch prior to video camera installation. NOTE: Video cameras cannot be a substitute to staff requirements. This facility is required to have awake staff at night. There is sufficient evidence to prove the allegation.

Based on interview conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Pursuant to Title 22, deficiencies are cited. See LIC 9099D.



An exit interview was conducted and a copy of this report and appeal rights was provided to Administrator Margaret Chen.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20251208083210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2025
Section Cited
CCR
85022(a)(2)
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Plan of Operation. The plan of operation shall contain written evidence of arrangements for any consultants and community resources which are to be utilized to meet regulatory requirements or requirements of the facility's plan of operation. This requirement was not met evidenced by:
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Administrator agreed to hire a behavior consultant that provides required semi-annual services per client.

1.Please submit a written plan of correction.
2. Submit the behavior consultant contract.
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Based on record review, the findings indicate that physical therapy consultant hours for 2 individuals did not meet the required program design, which states 7 hours of consultant hours shall be provided to each individual. The PT invoiced hours were less than the required per visit. This poses a potential health, safety, and personal risk.
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Type B
12/30/2025
Section Cited
CCR
80065(f)
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Personnel Requirements. All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement was not met evidenced by:
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Administrator shall ensure all required annual continuing education units and on-the-job training is completed.

1. Submit a written plan of correction that states how the deficiency will be corrected.

2. Staff training log with staff signatures

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Based on record review, none of the staff files have required continuing education and on-the-job training, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20251208083210
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHEN'S HOME, INC.
FACILITY NUMBER: 197803548
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2025
Section Cited
CCR
80022(j)
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Plan of Operation. Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061.

This requirement was not met evidenced by:
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Administrator shall submit to CCL a plan of operation Amendment pertaining to the use/access of video of surveillance cameras in the home, proof of resident's responsible party consent authorization, updated facility sketch with camera location, and a written plan that states cameras will not have audio.
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Based on observation, the facility has a total of 4 indoor and 1 outdoor bell Ring surveillance cameras with audio component. Licensee did not notify CCL or the Regional Center of plan of operation changes, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5