<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320090
Report Date: 11/05/2021
Date Signed: 11/05/2021 09:31:46 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 DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2021 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20211029152412
FACILITY NAME:SOUTH BAY FAMILY HOME, LLCFACILITY NUMBER:
198320090
ADMINISTRATOR:CHAVEZ, KARENFACILITY TYPE:
735
ADDRESS:21821 ARCHIBALD AVE.TELEPHONE:
(310) 919-8272
CITY:CARSONSTATE: CAZIP CODE:
90745
CAPACITY:4CENSUS: 1DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
11:17 AM
MET WITH:KAREN CHAVEZ TIME COMPLETED:
03:47 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility smelled of marijuana.
Facility staff is smoking at the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/05/21, Licensing Program Analysts (LPAs) Ernand Dabuet and Ngozi Nwaokoro conducted an unannounced complaint visit at this facility, LPA was greeted by the caregiver Segundina Thomas. LPA explained the purpose of today's visit was to gather information on the allegations mentioned above. Thomas contacted the administrator Karen Chavez by telephone was made aware of the visit and joined the team.

The investigation consisted of the following: An interview was conducted with Karen Chavez, (3) staff, and (1) client, and (2) witnesses. A review of the current staff and client roster and staff #1 (S1) personnel records and other pertinent records was reviewed. A tour of the physical plant was conducted.

Evaluation Report continues LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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-20211029152412
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
MONTERY PARK, CA 91754
FACILITY NAME: SOUTH BAY FAMILY HOME, LLC
FACILITY NUMBER: 198320090
VISIT DATE: 11/05/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility smelled of marijuana.
Facility staff is smoking at the facility.

It is alleged the facility smelled of marijuana and that staff #1(S1) was smoking at the facility. According to details provided to Community Care Licensing, on 10/28/21, the complainant entered the facility and noticed the smell of marijuana and incense. The complainant also observed ashes on the table a bit of material that looked organic. On 11/05/21 the Department conducted an unannounced inspection visit at this facility and inspected the entire facility and did not observe any ruminants of marijuana or incense. The Department interviewed staff #1(S1) and she denied the allegation. (S1) claims she does not engage with drugs or alcohol. (S1) claims she does not smoke marijuana or cigarettes. (S1) denies the facility ever smelled of marijuana. Interviews were conducted with staff #2-#4 (S2-S4) all disputed these allegations. (S2-S4) claimed they do not know any staff who engages with any type of drugs, alcohol, or marijuana while on duty. (S2-S4) all claimed they have not observed any staff show any physical, behavioral, or psychological signs that would be associated with a person who engages in marijuana habit. The Department interviewed witnesses #1-#2 (W1-W2) both stated they have not observed any strange or unusual behavior from staff. Furthermore, both witnesses stated have not smelled client #1(C1) with marijuana odor on her clothing. The Department interviewed (C1), with several questions related to the allegations but was not able to hold a conversation due to her disability. During today's inspection, the Department did not perceive the smell of marijuana in the facility. Based on information gathered, observation, interviews, there is no evidence to corroborate the allegations mentioned above.

Based on information gathered, the Department did not find sufficient evidence to support the allegations: "Facility smelled of marijuana" and "Facility staff is smoking at the facility".

Although the allegations may have happened or are valid, there is not enough preponderance of evidence to prove the alleged allegations are valid did or did not occur. Therefore, the allegations are "unsubstantiated.”

An exit interview was conducted with Karen Chavez, and a hard copy was provided via email.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2