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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320147
Report Date: 09/06/2022
Date Signed: 09/06/2022 11:50:25 AM

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
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220902150606
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR:ELLIOTT, SCOTTFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:18CENSUS: 16DATE:
09/06/2022
UNANNOUNCEDTIME BEGAN:
10:06 AM
MET WITH:ADMINISTRATOR CLAIRE ROATIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not following COVID protocols.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility on 09/06/2022 at around 10:00 AM 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 09/06/2022 approximately around 10:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 09/06/2022 LPA Calderon could not interview W1 for complaint due to W1 being anonymous. On 09/06/2022 LPA Calderon requested copies of the following: Staff and Resident rosters, infection control plan, covid19 training for staff. On 09/06/2022 LPA Calderon interviewed S1 – S4 for complaint. On 09/06/2022 LPA Calderon attempted to interview clients for complaint.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
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-20220902150606
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: ICAN CALIFORNIA ABILITIES NETWORK LONG BEACH
FACILITY NUMBER: 198320147
VISIT DATE: 09/06/2022
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
Regarding Allegation #1: Facility is not following Covid19 protocols.
On 09/06/2022 LPA Calderon was not able to interview W1 regarding complaint as W1 was anonymous. On 09/06/2022 LPA Calderon attempted to interview clients for complaint, but due to client’s disabilities clients were not able to answer questions. On 09/06/2022 LPA Calderon interviewed S1-S4 all state to follow Covid19 protocols, all wear mask while inside the facility. On 09/06/2022 LPA Calderon reviewed facility infection control plan and Covid19 training for staff for past 3 months. LPA Calderon also noted all staff were wearing masks, and following Covid19 rules.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of Facility is not following Covid19 protocols is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator S1.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2