198204399-11-16-2022-11-AS-EMAZ-CRJSYZ-20230505141823

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204399
Report Date: 11/16/2022
Date Signed: 11/16/2022 02:09:06 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: 59	DATE:	11/16/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR MARIA BRAVO		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not prevent resident from engaging in inappropriate behavior

INVESTIGATION FINDINGS:

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On 11/16/2022 around 9 am Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation regarding Villa Redondo Care Home Facility to deliver the investigation findings for the allegation listed above. LPA Calderon met with S1 and the purpose of the visit was explained.

The Investigation consisted of the following: On 11/16/2022 LPA Calderon interviewed S1and conducted a tour of the physical plant. On 11/16/2022 LPA Calderon obtained copies of Staff and Resident rosters, Needs and Service Plan, Physicians Report for R1 and R2, incident report, copy of police report for R1 and R2. On 11/15/2022 LPA Calderon interviewed staff S2-S4 regarding complaint and on 11/15/2022 LPA Calderon interviewed R1 for complaint. On 11/16/2022 LPA Calderon attempted to interview R2 for complaint. On 11/16/2022 LPA Calderon interviewed R3-R4 for complaint.

The investigation revealed the following:

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: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

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: 11/16/2022

NARRATIVE

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Allegation: Staff did not prevent resident from engaging in inappropriate behavior.
It is alleged that staff did not prevent resident from engaging in inappropriate behavior. 11/15/2022 LPA Calderon interviewed R1 who stated that around 7:30pm R1 was taking off R1 clothes and R1 noticed R2 top of R2 head and eyes were looking at R1 undressing. R1 states that R1 advised staff who came to the location and found R1 smoking near R1 window. R1 states but cannot prove that R2 has done this in the past, but that S1 has done nothing to stop R2 from doing the same thing over again. On 11/16/2022 LPA Calderon interviewed S1 who states that the next day S1 was informed of R1 allegation against R2. S1 states that S1 walked to the area of question and could not support R1 allegation against R2. S1 states that S1 confronted R2 who denied looking into R1 window but does admit R2 was in the area smoking when R1 claims R2 was. On 11/16/2022 LPA Calderon interviewed S2-S5 who state that R2 was in the area smoking but does not admit looking into R1 window. S2-S5 state that R2 physical issues would prevent R2 from looking into R1 window as claimed. On 11/16/2022 LPA Calderon interviewed S3-S4 who state to have heard of R1 allegation but has no firsthand knowledge of the issue and has never had anyone resident look into their window. R3-R4 has had no issues with staff or other residents. On 11/16/2022 LPA Calderon walked to the allegation location, noted R1 window which is located on the corner of the building near some steps. LPA Calderon walked into R1 room and R1 pointed out o LPA Calderon when R1 believes R2 was looking into R1 window. LPA Calderon noted that a unknown person would have to be 7-foot-tall or standing on a ladder to be able to investigate R1 room as claimed. On 11/16/2022 LPA Calderon reviewed facility records for R1 and R2. LPA Calderon noted that R1 diagnosis with bipolar and schizophrenia and R2 has no history of any inappropriate behavior while living at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A exit interview was conducted with S1, and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2022

LIC9099 (FAS) - (06/04)

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