198204374-12-28-2023-28-AS-RORN-CZBMG8-20240109083530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204374
Report Date: 12/28/2023
Date Signed: 12/28/2023 01:14:32 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
09/30/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220930100817

FACILITY NAME:	SIMLA VILLAS INC.		FACILITY NUMBER:	198204374
ADMINISTRATOR:	SIMLA MEHTA		FACILITY TYPE:	740
ADDRESS:	16623 ARDMORE AVENUE		TELEPHONE:	(562) 804-3603
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	15	CENSUS: 13	DATE:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	11:43 AM
MET WITH:	Jennifer Bobadilla - Administrator		TIME COMPLETED:	01:31 PM

ALLEGATION(S):

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Unlawful evicition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit regarding the allegation listed above. LPA met with Administrator Jennifer Bobadilla and explained the purpose for the visit.

The investigation consisted of the following: During the initial visit conducted on 10/06/2022, LPA Glenn Trueman interviewed Staff #1 - 5 (S1 - S5), Residents #2 - 5 (R2 - R5), and reviewed the file for Resident #1 (R1). During today's visit, LPA Zaragoza re-interviewed Staff #1 - 3 (S1 - S3), obtained the facility's Admission Agreement, House Rules, a Log for residents that sign out of the facility, and Staff Roster. LPA also interviewed Witness #1 (W1) over the phone. LPA attempted to interview R1, however they no longer live at the facility.

The investigation revealed the following: in regards to the allegation "Staff pushed resident", it is alleged that R1 was illegally evicted from the facility when R1 was signed out by a friend (W1) for a week, and then refused to be allowed back because R1's bed was already given to a new resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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-20220930100817

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: SIMLA VILLAS INC.	FACILITY NUMBER: 198204374
	VISIT DATE: 12/28/2023

NARRATIVE

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During interviews with the staff, none of the staff interviewed corroborated the allegation because they all stated that R1 was never evicted, therefore they never issued an eviction notice to R1. One of the staff interviewed explained that R1 stated that they did not want to live in the facility anymore, and signed out of the facility on their own accord with W1 who is a friend. Another staff member interviewed indicated that R1 said they wanted to live with their sibling rather than reside at the facility, and that is why they were signed out of the facility with W1 who is a friend of the family. The staff also explained that after about a week, W1 returned asking to place R1 back in the facility because they were not able to care for R1, however R1's bed was already filled with another resident. LPA obtained the phone number of W1 from the facility administrator and contacted W1 by phone to interview W1 about the allegation. W1 did recall R1 and confirmed that they are a friend of the R1's family, however W1 stated that they did not recall R1 being illegally evicted from the facility.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 held, and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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