197803708-8-19-2022-28-AS-MVAO-CJGSTM-20220921140945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803708
Report Date: 08/19/2022
Date Signed: 08/19/2022 12:25:34 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, 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
08/15/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220815091223

FACILITY NAME:	BURTREE RESIDENTIAL FACILITY		FACILITY NUMBER:	197803708
ADMINISTRATOR:	LAMAUIG, JOYCELYN		FACILITY TYPE:	735
ADDRESS:	16422 BURTREE STREET		TELEPHONE:	(626) 363-4162
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	6	CENSUS: 6	DATE:	08/19/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Facility Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not manage pets in the home to prevent resident from sustaining an injury
Staff forced resident to share space with an animal resident is allergic to

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10 day complaint visit to investigate the above allegations. LPA met with the Facility Administrator and explained the purpose of today's visit.

During this investigation, LPA obtained a copy of the client roster and staff roster. LPA reviewed client files for Client #1 (C-1) and Client #2 (C-2) and obtained relevant documentation. LPA also interviewed the Facility Administrator, Client #1 through Client #6 (C-1 through C-6). Additionally, LPA conducted a tour.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

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-20220815091223

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: BURTREE RESIDENTIAL FACILITY	FACILITY NUMBER: 197803708
	VISIT DATE: 08/19/2022

NARRATIVE

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Allegation: Staff did not manage pets in the home to prevent client from sustaining an injury. Facility Administrator indicated that C-1 has resided at this facility for approximately 9 months and C-2 has been residing at this facility since August 2019. Both C-1 and C-2 share the same room. Per Facility Administrator, the cat belongs to C-2 and the cat does not stay inside this facility (cat has a bed and cage outside in the backyard). Per Facility Administrator, C-2’s cat was already on premises prior to C-1 moving in. Per Facility Administrator, C-2’s cat is a friendly cat. Per Facility Administrator, there has not been any reports of the cat scratching clients nor any reports of any clients sustaining an infection from a scratch. Client interviews revealed that the cat belongs to C-2 and that the cat has been at this facility for approximately (1) year. Client interviews revealed that the cat is friendly does not scratch clients. LPA also conducted a tour of this facility and did not observe the cat or anything belonging to the cat inside the home. LPA observed the cat’s bed and cage to be in the backyard. Interviews and tour do not corroborate this allegation.

Allegation: Staff forced client to share space with an animal client is allergic to Facility Administrator indicated that C-1 has resided at this facility for approximately 9 months and C-2 has been residing at this facility since August 2019. Both C-1 and C-2 share the same room. Per Facility Administrator, there has not been any reports of the any clients being allergic to cats. Per Facility Administrator, there has not been any requests from clients requesting to move to another room due to “allergies associated with cats”. Per Facility Administrator, there has not been any threats of eviction nor has any client been forced into staying in a room with a cat. Client interviews revealed that C-2’s cat stays outside the facility. Interviews do not corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted, a copy of this report and Appeal Rights were provided to Facility Administrator.

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2022

LIC9099 (FAS) - (06/04)

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