198204399-12-16-2022-11-AS-EMAZ-CRJSYY-20230505141817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 12/16/2022
Date Signed: 12/16/2022 01:00:27 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
11/07/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20221107113453

FACILITY NAME:	VILLA REDONDO CARE HOME		FACILITY NUMBER:	198204399
ADMINISTRATOR:	MARIA BRAVO		FACILITY TYPE:	740
ADDRESS:	237 REDONDO AVENUE		TELEPHONE:	(562) 434-9931
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90803
CAPACITY:	80	CENSUS: 56	DATE:	12/16/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMIN DAVID HERNANDEZ		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not prevent resident from engaging in inappropriate behavior

INVESTIGATION FINDINGS:

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On 12/16/2022 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Villa Redondo Care Home. On 11/16/2022 at around 09:00 AM LPA Calderon and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10 day visit on 11/16/2022 approximately around 09:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 11/15/2022 LPA Calderon interviewed W1 for complaint. On 11/16/2022 LPA Calderon requested copies of the following: Staff and Resident rosters, admission agreement. On 08/17/2022 LPA Calderon interviewed R1-R5 for complaint. On 11/16/2022 LPA Calderon interviewed S1 – S4 for complaint.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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-20221107113453

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: VILLA REDONDO CARE HOME	FACILITY NUMBER: 198204399
	VISIT DATE: 12/16/2022

NARRATIVE

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Regarding Allegation #1: Staff did not prevent resident from engaging in inappropriate behavior. On 11/15/2022 LPA Calderon interviewed W1 who states that W1 was taking W1 clothes while in W1 room around 7:30 PM. W1 states W2 was standing outside W1 window and was looking inside W1 room and watched W1 undress. W1 states that W2 was smoking outside W1 window. On 11/16/2022 LPA Calderon and S1 walked outside of W1 room window. LPA Calderon noted there was a walkway and steps in the area. Based on W1 statement as to where W2 was looking at W1 window W2 would have to use a ladder or be 9 foot tall. On 11/16/2022 LPA Calderon interviewed S1-S5 who all state that W2 was in the area smoking but denied looking inside W1 window or looking at W1 undress. On 11/16/2022 LPA Calderon interviewed R2-R5 all state to know W2 and state to have no issues with W2 since W2 has been living at the facility. On 11/16/2022 LPA Calderon interviewed W2 who states W2 was smoking in the area but denies looking at W1 undressing.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of Staff did not prevent resident from engaging in inappropriate behavior is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator (S1).

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

LIC9099 (FAS) - (06/04)

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