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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 03/28/2024
Date Signed: 03/28/2024 10:43:36 AM

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
03/22/2024 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240322082242
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: 65DATE:
03/28/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Adela SantosTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff did not address client’s self-neglecting behaviors.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a visit to investigate the above allegation. LPA met with Adela Santos and discussed the purpose of today's visit.

During this investigation, LPA obtained a copy of the staff and client rosters, reviewed C-1's file and obtained relevant documentation, interviewed Staff #1 (S-1) through Staff #4 (S-4) and interviewed Client #2 (C-2) through Client #6 (C-6). LPA was unable to interview C-1 as C-1 is currently hospitalized due to a mental health condition. LPA attempted to contact C-1's Public Guardian and was unsuccessful.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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-20240322082242
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: HAMILTON VILLA
FACILITY NUMBER: 198600271
VISIT DATE: 03/28/2024
NARRATIVE
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Allegation: Facility staff did not address client’s self-neglecting behaviors. Interviewed staff indicated that staff continuously encourage C-1 to shower and C-1 refuses. Interviewed staff indicated that they have observed C-1 to have lice and have offered C-1 treatment for lice and C-1 refuses. Per staff interviews, staff have not observed C-1 to have scabies nor lesions. Interviewed staff indicated that C-1's clothes and linens are washed on a consistent basis to prevent the spread of lice. On 03/18/24, C-1 was hospitalized due to aggression and non-compliance with staff (including physical hygiene). Client interviews revealed that C-1 refuses to shower. Per client interviews, clients have not observed C-1 to have lesions and/or rashes. Staff and client interviews do not corroborate this allegation.

Based on record review and interviews conducted the findings indicate, 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.

An exit interview conducted, appeal rights and a copy of this report was provided to Adela Santos.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
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