198205266-8-8-2022-28-AS-LHIS-CHZUTX-20220906155240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205266
Report Date: 08/08/2022
Date Signed: 08/08/2022 12:00:16 PM

Unsubstantiated

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 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
08/05/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220805131156

FACILITY NAME:	CAMELOT RESIDENTIAL HOME		FACILITY NUMBER:	198205266
ADMINISTRATOR:	JEFFERSON BAUTISTA		FACILITY TYPE:	740
ADDRESS:	10337 BEACH STREET		TELEPHONE:	(562) 866-3955
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	20	CENSUS: 16	DATE:	08/08/2022
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Administrator Evangeline De Casa		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff failed to prevent the sale of drugs at facility
Staff failed to prevent drug usage on the premises
Client masturbating in front of other clients

INVESTIGATION FINDINGS:

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On 8/08/22 at 9:05 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with S1 and explained the purpose of the visit. At 9:33 Administrator Evangeline De Casa joined the visit.

The investigation consisted of the following: During today’s visit LPA toured the facility, obtained the resident/ staff roster, and obtained a copy of the house rules. LPA interviewed Administrator, S1 and S2. LPA interviewed R1 through R5, and R6 declined interview.

Report Continued on 9099c.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

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 28-AS-20220805131156

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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CAMELOT RESIDENTIAL HOME	FACILITY NUMBER: 198205266
	VISIT DATE: 08/08/2022

NARRATIVE

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The investigation reveals the following: In regard to “Staff failed to prevent the sale of drugs at facility”. The details of this allegation state that drug dealing is occurring in the facility. Administrator confirmed that the facility has not seen or heard of drug dealings in the facility. Administrator stated that there is a no tolerance for illegal drugs in the facility per house rules. 2/2 staff stated they have not seen or heard of drug dealings in the facility. 4/5 residents stated they have not seen or heard of staff or clients dealing drugs in the facility. 1/5 residents stated roommate deals drugs in the facility. Room mate was interviewed and declined the allegation.

The investigation reveals the following: In regard to " Staff failed to prevent drug usage on the premises ". The details of this allegation state that R1 roommate (R2) use drugs in the facility. Administrator confirmed there are no drug usage in the facility. 2/2 stated they have not seen residents use drugs in the facility.4/5 residents confirmed that they have not seen other residents use drugs in the facility. 1/5 residents stated room mate use drugs in the facility. R2 denied drug usage

The investigation reveals the following: In regard to “Client masturbating in front of other clients”. The details of this allegation state that R2 masturbate in front of R1. Administrator stated the facility have not received any complaints from residents regarding the above allegation. Administrator confirmed R1 family member informed administrator of concerns and the facility investigated the incident. Administrator spoke to R2 and R2 declined the allegation. Administrator has now moved R1 to a private room. 2/2 staff stated they have not received complaints from residents regarding the above allegation. 4/5 clients stated that they have not witness other residents masturbating in front of them. 1/5 residents stated roommate was watching porn and masturbated to which he also watched the porn on roommates TV. R2 decline the allegation.

Based on LPA's interviews, investigation revealed: 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.

Exit interview conducted with Evangeline De Casa and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC9099 (FAS) - (06/04)

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