198320342-10-30-2024-11-AS-JHAD-DAU2NQ-20241108163306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320342
Report Date: 10/30/2024
Date Signed: 10/30/2024 01:59:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2024 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241022135922

FACILITY NAME:	OLIVE TREE HOME		FACILITY NUMBER:	198320342
ADMINISTRATOR:	DUNGCA, ROMMEL		FACILITY TYPE:	740
ADDRESS:	1035 OLIVE AVE		TELEPHONE:	(562) 432-1163
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	18	CENSUS: 17	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Cezar Tuazon		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not safeguard resident funds.

INVESTIGATION FINDINGS:

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On 10/30/24, at 9:30am, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint visit to the facility and was greeted by Cezar Tuazon Jr., Direct Care Staff, and later by Rommel Dungca, Administrator. LPA explained the purpose of this visit is to conduct interviews, gather facility files, and render findings in the complaint.

The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint and conducted interviews with staff (S1-S3) and residents (R1-R7). Additionally, LPA obtained the following documents: Resident Roster (Dated: 7/05/2024), Staff Roster (Dated: 9/13/2023), Admission Agreement (Dated: 06/27/2022), Physicians Report (Dated: 06/02/2022), ID/Emergency Information (Dated: 06/28/2022), Appraisal/Needs And Services Plan (Dated: 06/28/2022), Client/Resident Personal Property And Valuables (Dated: 06/28/2022), Safeguarded Cash Resources (Dated: 08/06/2024-10/22/2024), Surety Bond (Dated: 10/28/2022), House Rules (Dated: No Date), and Visitation Sign in Sheet (Dated: 09/19/2024-10/30/2024) from the facility.

Complaint Investigation Report Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20241022135922

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: OLIVE TREE HOME	FACILITY NUMBER: 198320342
	VISIT DATE: 10/30/2024

NARRATIVE

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The investigation revealed the following: Allegation-Staff did not safeguard resident funds.

The details of the complaint alleged that the resident’s wallet was stolen by another resident in the facility that contained about $500.00. On 10/30/24, from 09:00am-2:00pm, LPA interviewed staff (S1-S3) and residents (R1-R7) regarding the allegation. 3 of 3 staff (S1- S3) denied the allegation that the facility Staff did not safeguard resident funds. All staff (S1-S3) stated that the facility does safeguard the residents’ funds. They state that the facility has a safe that safeguards their P & I money. Staff stated that the resident (R1) misplaced R1s wallet and they looked for the wallet but could not find it. The staff denies that the wallet contained $500.00 because according to staff, all R1s money from R1s P & I funds are kept in the safe. They state the resident has $1,716.00 available. They also state that P & I funds are issued on the 1^st or the 3^rd of each month. And once the funds are distributed, the residents must sign for it.

The department reviewed the Safeguarded Cash Resources (Dated: 08/06/2024-10/22/2024) and observed that R1 was supposed to have $1,716.00 in P & I money. The department had the staff count the cash for R1 that was locked in the facility safe, and verified the amount was accurate with R1s signatures. The department also observed the Client/Resident Personal Property and Valuables (Dated: 06/28/2022) and noted that R1 had no valuables listed.

LPA interviewed residents R1-R7 about the allegation and 6 of 7 residents that were interviewed denied the allegation that the facility Staff did not safeguard resident funds. The majority of the residents (6 of 7) interviewed stated that the facility does safeguard their funds and have not had an issue with theft in the facility.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff did not safeguard resident funds. 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.

No citations were issued for this complaint.

An exit interview was conducted with Cezar Tuazon Jr., Direct Care Staff, and a copy of this Complaint Investigation Report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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