198600140-9-6-2024-28-AS-RORN-D92MRW-20240912095102

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600140
Report Date: 09/06/2024
Date Signed: 09/06/2024 03:51:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240904080802

FACILITY NAME:	SALEM HOME		FACILITY NUMBER:	198600140
ADMINISTRATOR:	DELORES BERINTI		FACILITY TYPE:	735
ADDRESS:	4122 KIMA CT		TELEPHONE:	(562) 634-1256
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY:	4	CENSUS: 3	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Ronald Bautista - Administrator		TIME COMPLETED:	04:06 PM

ALLEGATION(S):

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Facility staff touched a client's private area.
Facility staff yelled at a client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit regarding the above allegations. LPA met with Ronald Bautista (Administrator) and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of the staff and client roster. LPA interviewed the Administrator, Staff 1 - Staff 2 (S1 - S2), Client 1 - Client 3 (C1 - C3), and Regional Center Representative.

The investigation revealed the following: regarding the allegation "facility staff touched a client's private area", it is alleged that the Administrator and S1 touched C1's front private area and C1's butt. C1 stated that both the Administrator and S1 touched C1's front private area and butt while showering. Administrator, S1 and S2 denied the allegation and stated that C1 was able to independently shower and dress self, and staff only supervise from outside the bathroom. C2 and C3 could not corroborate the allegation, and stated that the clients shower on their own and the staff are outside the bathroom. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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 28-AS-20240904080802

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: SALEM HOME	FACILITY NUMBER: 198600140
	VISIT DATE: 09/06/2024

NARRATIVE

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Regarding the allegation "facility staff yelled at a client", it is alleged that the Administrator yelled at C1. Administrator denied the allegation and stated that he maintains a respectful relationship with all clients. Staff interviewed denied the allegation and stated that the Administrator is caring and attentive with all clients. C1 stated that Administrator yelled at C1 a couple of times because the Administrator is just mean and rude. C2 and C3 could not corroborate the allegation and described the Administrator as kind and respectful.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview held and a copy of the report was provided

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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