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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 08/29/2023
Date Signed: 08/29/2023 04:32:41 PM

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 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
08/22/2023 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230822150517
FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 62DATE:
08/29/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adela Santos TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff lock the facility gates during hours of operation.
Facility does not have air conditioning.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted an initial complaint visit in response to the allegations listed above. LPA met with DSP, Christopher Novales. Mr. Novales called administrator Adela Santos to let him know of the visit. Ms. Santos arrived at the facility a short time later and assisted with the visit.

The investigation consisted of interviews with Administrator, staff #1 - staff #4, and resident #1 - resident #5, tour of facility, and review of pest control invoices.

Regarding the allegation that : Staff lock the facility gates during hours of operation. Administrator and staff interviewed denied the allegation. Administrator and staff stated that sometimes the gates are closed, but they are never locked. Residents were unable to corroborate the allegation. 4 out of 5 residents stated that the gates are not locked. LPA observed that the gates were not locked on today's visit.

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
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 4
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 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
08/22/2023 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230822150517

FACILITY NAME:HAMILTON VILLAFACILITY NUMBER:
198600271
ADMINISTRATOR:ADELA SANTOSFACILITY TYPE:
735
ADDRESS:948 SOUTH HAMILTON BLVD.TELEPHONE:
(909) 620-1933
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY:84CENSUS: 62DATE:
08/29/2023
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adela Santos TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility has pests.
INVESTIGATION FINDINGS:
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Regarding the allegation that : Facility has pests, specifically roaches and mice. Administrator and staff interviewed admitted that there are pests at the facility. Administrator stated that they have a contract with a pest control company that comes to the facility once or twice a month. Residents interviewed corroborated the allegation. 5 out of 5 residents interviewed stated that they have seen roaches and mice in the facility.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 Division 6, Chapter 1.

An exit interview was conducted with Ms. Santos. A copy of the report and appeal rights were provided.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20230822150517
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HAMILTON VILLA
FACILITY NUMBER: 198600271
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2023
Section Cited
CCR
80087(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not being met as evidenced by:
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Administrator will submit a plan to LPA explaining how she will ensure that the facility is free of roaches and mice by POC due date. Administrator will also submit detailed pest control invoices to LPA monthly, until the facility is free of pests.
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Administrator, staff, and residents interviewed confirmed that the facility has mice and roaches.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20230822150517
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HAMILTON VILLA
FACILITY NUMBER: 198600271
VISIT DATE: 08/29/2023
NARRATIVE
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Regarding the allegation that : Facility does not have air conditioning. Administrator and staff interviewed stated that the facility has ceiling fans, and portable fans for residents. Residents interviewed stated they have ceiling fans and some residents stated they also have portable fans. 3 out of 5 residents interviewed stated that they are comfortable with the temperature in their room. It should be noted that title 22 regulations do not require facilities to have air conditioning.

Regarding the allegation that : Facility is in disrepair, specifically that the shower(s) and toilet(s) are not working properly. Administrator and staff interviewed denied the allegation. They stated that sometimes the toilets get clogged, but the facility staff repair them right away. Administrator and staff interviewed denied that the showers are not working. Residents interviewed were not able to corroborate the allegation. 5 out of 5 residents confirmed that sometimes the toilets get clogged, but staff repair it right away. 5 out of 5 residents stated that the shower(s) are working. LPA observed that the toilets and showers were functioning on today's visit.

Based on LPA's observations and interviews, investigation revealed: Although the allegation 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4