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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320161
Report Date: 06/13/2022
Date Signed: 06/21/2022 08:43:03 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
06/03/2022 and conducted by Evaluator Lourdes Montoya
COMPLAINT CONTROL NUMBER: 11-AS-20220603131643
FACILITY NAME:DENVER RESIDENTIAL FACILITY, INC DBA DENVER RESIDFACILITY NUMBER:
198320161
ADMINISTRATOR:ALLEN, LYNN TIFACILITY TYPE:
735
ADDRESS:14410 S DENVER AVETELEPHONE:
(810) 756-3839
CITY:GARDENASTATE: CAZIP CODE:
90248
CAPACITY:4CENSUS: 4DATE:
06/13/2022
UNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Jeanette KiddTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Unlawful eviction.
INVESTIGATION FINDINGS:
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On 6/13/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. Upon arrival, LPA called the facility to conduct a risk assessment. LPA spoke with Licensee Jeanette Kidd who confirmed the facility is Covid-19 free. LPA met with Licensee Jeanette Kidd shortly after and explained the purpose of today's visit.

The investigation consisted of the following: LPA Lourdes Montoya asked questions pertinent to the allegation. LPA conducted a tour of the inside and outside grounds of the facility with Licensee Jeanne Kidd. LPA observed the licensee (S1), three staff (S2-S4) and one client (C1) present during the visit. LPA Montoya interviewed the Licensee (S1) and three staff (S2-S4). LPA was unable to interview Client #1 because Client #1 is non-verbal. LPA interviewed two witnesses (W1 and W2) by telephone. LPA requested and obtained Client#1's service records and other pertinent records.

Report continued on LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
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-20220603131643
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: DENVER RESIDENTIAL FACILITY, INC DBA DENVER RESID
FACILITY NUMBER: 198320161
VISIT DATE: 06/13/2022
NARRATIVE
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INVESTIGATIONS REVEALED THE FOLLOWING:

Allegation: Unlawfully evicted.

The Complainant or Reporting Party (RP) alleges Client #1 was unlawfully evicted. RP reported Client #1 was transported to the Memorial Hospital of Gardena on 06/02/22 for aggression and agitation behavior. RP stated Client #1 was given medication and was “medically cleared” to return to the facility shortly after he arrived at the hospital, but Client #1 was not allowed back to the facility. The department interviewed the licensee (S1), three staff (S2-S4) and two witnesses (W1-W2). Based on interviews with S1-S4 and W1-W2, Client #1 was not evicted. S1 and S2 stated on 6/2/2022, Client #1 displayed aggressive and violent behavior towards another client. S2 stated she attempted to redirect Client #1 but he continued to cuss and yell at clients and staff, and he began to throw stuff at them. S2 stated Client #1 picked up a hoyer lift and attempted to throw it on staff. S2 stated she was hit by Client #1 on the head. S1 stated she called 911 due to Client #1’s uncontrolled and violent behavior. Client #1 was taken to Memorial Hospital of Gardena and shortly after a Social worker from the hospital called the facility to discharge Client #1. S1 admitted she told the hospital social worker that it is not safe for other clients and staff as well as for Client #1 to return to the facility without proper evaluation by a Psychiatrist. S1 stated she requested that Client #1 gets a proper evaluation prior to returning to the facility. Interviews with Witness #1 and Witness 2 revealed Client #1 was not evicted. S3 revealed in the interview that he observed Client #1 transported back to the facility on 6/4/2022. Based on interviews and record reviews, there is no sufficient evidence to corroborate the allegation mentioned above.

Based on information gathered, LPA did not find sufficient evidence to support allegation, "Unlawfully evicted”.



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 conducted and a copy of the report was provided to Licensee Jeanette Kidd.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2