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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 12/20/2021
Date Signed: 12/20/2021 03:51:38 PM



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
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20211214125113
FACILITY NAME:VILLA REDONDO CARE HOMEFACILITY NUMBER:
198204399
ADMINISTRATOR:MARIA BRAVOFACILITY TYPE:
740
ADDRESS:237 REDONDO AVENUETELEPHONE:
(562) 434-9931
CITY:LONG BEACHSTATE: CAZIP CODE:
90803
CAPACITY:80CENSUS: 48DATE:
12/20/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Maria BravoTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Resident Is being Illegally Evicted.
INVESTIGATION FINDINGS:
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On 12/20/21 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced complaint visit Regarding the allegation above. LPA was met by Facility Administrator Maria Bravo, and the purpose of the visit was explained.

The investigation consisted of the following: Record Review, and Interviews.

Regarding Allegation: "Resident is being illegally evicted"
On 11/17/21 LPA was sent an Incident Report notifying that Resident (R1) was being evicted from the facility effective 12/17/21. Reason given “Failure of payment within 10 days.” R1 was issued a 30 day notice in writing on 11/17/21. R1 has a total unpaid balance of $3276.22 and has not paid to date, 12/20/21. Last payment received was on Oct 21st, 2021.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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 2
Control Number 11-AS-20211214125113
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
MONTEREY PARK, CA 91754
FACILITY NAME: VILLA REDONDO CARE HOME
FACILITY NUMBER: 198204399
VISIT DATE: 12/20/2021
NARRATIVE
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Title 22 Regulations, (Chapter 6, Division 8) 87224 Indicates that “The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)(1) Nonpayment of the rate for basic services within ten days of the due date.

Based on Lpa interviews, and record review, this agency has investigated the complaint alleging
“Resident is being illegally evicted” We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.”

An Exit Interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
LIC9099 (FAS) - (06/04)
Page: 1 of 3