198320155-7-19-2023-11-AS-MVAO-CXYTV7-20231127140325

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320155
Report Date: 07/19/2023
Date Signed: 07/19/2023 03:30:29 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
07/13/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20230713093000

FACILITY NAME:	REM CALIFORNIA LLC - BALTIC		FACILITY NUMBER:	198320155
ADMINISTRATOR:	WHITLEY JOHN		FACILITY TYPE:	735
ADDRESS:	2800 BALTIC AVE		TELEPHONE:	(562) 424-9555
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90810
CAPACITY:	3	CENSUS: 3	DATE:	07/19/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	ADMINISTRATOR WHITLEY JOHN		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Client engaged in inappropriate interaction with client in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to REM California LLC -Baltic facility on 07/19/2023 and was greeted by Director Verretta Boatner (A1). LPA Calderon spoke to A1 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 allegations.

During this investigation, LPA Calderon interviewed A1, S1-S2 and interview R1-R2. These interviews were conducted on 07/19/2023. On 07/19/2023 LPA Calderon requested copies of the following: Staff and Resident rosters, Needs and Service plan for R1-R2, Incident reports for complaint and any other reports for R1-R2.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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-20230713093000

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: REM CALIFORNIA LLC - BALTIC	FACILITY NUMBER: 198320155
	VISIT DATE: 07/19/2023

NARRATIVE

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Regarding Allegation #1: Client engaged in inappropriate interaction with client in care.

The alleged client engaged in inappropriate interaction with another client. On 07/19/2023 LPA Calderon interviewed A1 for complaint. A1 relays that the supposed incident happened 2 or 3 months ago and the R1 relays to A1 that R2 had touched R1 private parts. A1 relays that R1 never advised any staff that R2 had touched R1 private parts. On 07/19/2023 LPA Calderon interviewed S1 for complaint. S2 states that R2 does not have a history of touching any other resident inappropriately and relays R1 had advised S2 that R2 touched R1 private parts while in the facility van. S1 relays that R1 relays that R2 touched R1 private parts 2 or 3 months ago and R1 never reported the incident to staff. On 07/19/2023 LPA Calderon attempted to interview S2 for complaint, but S2 did not return LPA call and S2 no longer works for facility. On 07/19/2023 LPA Calderon interviewed R1-R2 for complaint. R1 relays that R2 had touched R1 private parts 2 or 3 months ago while R1 was inside R1 room. R1 relays that R2 has touched his private parts many times in the past but R1 relays that R1 did not report R2 actions because R1 did not want R2 to get mad at R1. R1 relays that R2 comes into R1 room to watch tv and then touches R1. R2 relays that R2 never touched R1 private parts and that R1 is not telling the truth. R2 relays that he watches tv from the hallway of R1 room and does not enter R1 room as R1 will get mad. R2 relays that R1 comes into R2 room and wakes R2 up from sleeping by touching R2 legs and arms. R2 relays that he would never touch R1 private parts ever. On 07/19/2023 LPA Calderon reviewed R1-R2 needs and service plan. R1-R2 both have health issues and emotional, behavioral, and physical limitations. R2 does get aggressive with other staff and residents. R2 does not have history of touching other residents in care. LPA Calderon did not review any prior incident reports for R2 touching another resident inappropriately in care.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “Client engaged in inappropriate interaction with client in care” is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report were provided to the Director Verretta Boatner (A1)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC9099 (FAS) - (06/04)

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