197803954-9-15-2022-11-AS-EMAZ-CK6VN5-20221013163435

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197803954
Report Date: 09/15/2022
Date Signed: 09/15/2022 04:24:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/14/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220914153252

FACILITY NAME:	AMYTONY HOME IV		FACILITY NUMBER:	197803954
ADMINISTRATOR:	MELANIE ESTEPA		FACILITY TYPE:	735
ADDRESS:	1924 SHIPWAY AVENUE		TELEPHONE:	(562) 795-9162
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	4	CENSUS: 4	DATE:	09/15/2022
		UNANNOUNCED	TIME BEGAN:	12:53 PM
MET WITH:	Maria Sunio		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Facility A/C is in disrepair.

INVESTIGATION FINDINGS:

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On 09/15/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility. LPA Dabuet was greeted by administrator Maria Sunio. LPA Dabuet met with the administrator and explained the purpose of today's visit.

The investigation included the following; A review of the Client roster, Staff roster and other pertinent documents associated the allegation. Interviews were conducted with clients #1- #4 (C1-C4), staff #1 - #3 (S1-S3) and witness #1 (W1). A tour of the 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: 09/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022

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 11-AS-20220914153252

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: AMYTONY HOME IV	FACILITY NUMBER: 197803954
	VISIT DATE: 09/15/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility A/C is in disrepair.

The details of the complaint stated the facility had air conditioning that was not in working condition. The complainant requested for Community Care Licensing to inspect this facility because it was noted that the A/C was inoperative. On 09/05/22 complainant was given information the facility did not have air conditioning working during the heat wave.

The Department conducted a plant inspection on 09/15/22 at 1:27 pm and found the temperature in the facility to be within Title 22 regulations. Ceiling fans in all the bedrooms and free-standing fans in the dining room and rear bedroom are in operating condition. The room temperatures in front bedroom #1 is 81.5 degrees; bedroom #2 is 82.4 degrees; bedroom #3 is 82.4 and rear bedroom #4 is 82.4 degrees. The kitchen, dining, and activity rooms had temperatures of 81.6 - 84.4 degrees. Interviews with staff #1-#3 verified (S1-S3) that the home is not equipped with air conditioning and only equipped with heating. In an interview with the property owner witness #1 (W-1) claims the home was purchased in 2001 and did not have built-in central air conditioning units. A review of public records states this facility is a single-family home built in 1954 with 4 bedrooms and 2 baths with 1,712 square feet home that has heating and no cooling system.

The Department attempted to interview clients #1-#4 (C1-C4) who were present at the facility, however, were unable to hold a conversation as a result of their disability. Based on information gathered, an inspection of the facility, observation, analysis of public records, and interviews conducted, the Department found no evidence to support the allegation mentioned above.

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 were cited during this visit.
An exit interview was conducted with Maria Sunio, and a copy of the report was provided.

This report serves as an amendment to clarify finding on line #16. It does not supersedes the complaint investigation findings reflected on report created 09/15/22_.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022

LIC9099 (FAS) - (06/04)

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