197803692-9-2-2021-11-AS-EMAZ-C7BVH7-20210929162641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803692
Report Date: 09/01/2021
Date Signed: 09/02/2021 09:17:46 AM

Unsubstantiated

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 DR #100
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/31/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210831083724

FACILITY NAME:	BETTER LIVING HAVEN OF GARDENIA		FACILITY NUMBER:	197803692
ADMINISTRATOR:	ZARAGOZA, ERLYN R.		FACILITY TYPE:	735
ADDRESS:	5920 GARDENIA AVENUE		TELEPHONE:	(562) 423-0775
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	4	CENSUS: 4	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	NESTOR ZARAGOZA		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is physically abusive to client.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/01/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint inspection visit at this facility, LPA was welcomed and met with Nestor Zaragoza administrator and explained the purpose of today's visit was to gather information and conduct interviews regarding the allegation mentioned above.

The investigation consisted of the following: LPA interviewed staff #1-#4 (S1-S4), clients #1-#4 (C1-C4), witnesses #1-#4 (W1-W4). A review of (C1's) service records and other pertinent documents relevant to the nature of the complaint. A tour of the entire facility was conducted.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

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 3

Control Number 11-AS-20210831083724

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BETTER LIVING HAVEN OF GARDENIA	FACILITY NUMBER: 197803692
	VISIT DATE: 09/01/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff is physically abusive to client.

During this investigation, LPA reviewed C-1's service records and interviewed staff #1-#4 (S1-S4), clients #1-#4 (C1-C4), and witnesses #1-#4 (W1-W4) and found there is no evidence to support the allegation mentioned above.

It was alleged that (C1) is physically abused while in care. The complainant did not have date or time when the alleged incident occurred. The Department examined (C1) and found no apparent skin injury or discoloration on face and back. During an interview with (C1), he does not recall mentioning he was physically hit by staff #2 (S2). (C1) state staff treat well and he mentioned (S1) and (S2) as primary staff members he is fond of. (C1) denies having been involved with any type of physical abuse from any staff at this facility.

An interview with (S1-S4) all claimed this allegation is manufactured and it is untrue. (S1-S4) all claim that they care a great deal and respect for their clients and that any type of abusive behavior is unacceptable. The administrator affirmed no such thing ever occurred, neither conceived nor attempted. The administrator communicated that all staff conducts body checks daily and he had not received any information from staff stating that they observed bruising or injuries on (C1). This would have been documented on (C1’s) progress notes as well as notifying the local regional center and adult and senior care division in writing with an incident report. An interview with (C2) expressed he enjoys living in this facility and he has not experienced or witness any type of physical mistreatment from staff. (C2) asserted that he would notify another staff immediately if he ever encounters or observes such behavior.

The Department reviewed (C3-C4) service records and attempted to interview them and were unable to hold a conversation as a result of their disability. An interview with witnesses (W1-W4) and found there is no immediate health or safety concern with the consumer's total care at this facility. Based on observation, record reviews, and interviews there's no evidence to corroborate the allegation mentioned above.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210831083724

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 DR #100
MONTERY PARK, CA 91754

FACILITY NAME: BETTER LIVING HAVEN OF GARDENIA	FACILITY NUMBER: 197803692
	VISIT DATE: 09/01/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on information gathered, observation, interviews, service records, and other pertinent resources reviewed, there is no evidence to support the allegation: “Staff is physically abusive to client”

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.

No Deficiencies cited under California Code of Regulations Title 22.

An exit interview was conducted with Nestor Zaragosa and a copy of the report was provided by email.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3