198600271-9-19-2024-28-AS-TVAO-D9AN9M-20240920101610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600271
Report Date: 09/19/2024
Date Signed: 09/19/2024 12:52:17 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
06/25/2024 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240625150454

FACILITY NAME:	HAMILTON VILLA		FACILITY NUMBER:	198600271
ADMINISTRATOR:	ADELA SANTOS		FACILITY TYPE:	735
ADDRESS:	948 SOUTH HAMILTON BLVD.		TELEPHONE:	(909) 620-1933
CITY:	POMONA	STATE: CA	ZIP CODE:	91766
CAPACITY:	84	CENSUS: 61	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Adela Santos		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Personal Rights/Client is being sexually abused while in care.
Client's room is in disrepair.
Staff did not safeguard client's belongings.
Staff do not provide client with appropriate bed linens.
Staff do not ensure that the client's room is free of pests.
Staff did not notify client's responsible party of incident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an unannounced visit to deliver this report. This is a corrected version of the report dated 08/20/24. The purpose of this report is to include additional information to (1) allegation. LPA met with Adela Santos and explained the purpose of this visit.

On 06/27/24, LPA Irra conducted the initial investigation visit. During this visit, LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA reviewed Client #1's (C-1's) file and obtained relevant documentation. Additionally, LPA obtained a copy of the staff roster and a copy of the client roster.

***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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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

Control Number 28-AS-20240625150454

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: 09/19/2024

NARRATIVE

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During the course of this investigation, LPA interviewed Staff #1 (S-1) through Staff #4 (S-4), interviewed Client #2 (C-2) through Client #6 (C-6) and conducted a facility tour. LPA was unable to interview C-1 as C-1 moved out from this facility on 07/10/24. Additionally, Investigator Sonia Sandoval (Department of Social Services- Investigative Bureau/IB) attempted to interview C-1 several times to obtain additional information pertaining to the sexual abuse allegation and was unsuccessful. Per Investigator Sandoval, C-1 refused to provide information.

Personal Rights/Client is being sexually abused while in care. It has been alleged that C-1 is being sexually molested at night when C-1 sleeps and is afraid to report the perpetrators. Per S-1, C-1 moved out of this facility on 07/10/2024. Investigator Sonia Sandoval (Department of Social Services- Investigative Bureau/IB) attempted to interview C-1 several times to obtain additional information pertaining to the sexual abuse allegation and was unsuccessful. Per Investigator Sandoval, C-1 refused to provide information. Staff interviews revealed that C-1 had a history of fabricating stories. Interviewed staff indicated they have not received any reports from any clients being molested at this facility (including C-1). Interviewed staff indicated they are trained in mandated reporting. Client interviews revealed that they have not been sexually molested by anyone at this facility. Interviewed clients indicated they have not witnessed nor heard of anyone stating that they have been molested by anyone at this facility. Interviewed clients indicated they do not have any concerns. Interviews do not corroborate this allegation.

Client's room is in disrepair. It has been alleged that C-1’s room has holes in the walls that have not been repaired which allows cockroaches to enter the room. Staff interviews revealed that C-1 had a history of destroying facility property. Interviewed staff indicated that C-1 was putting holes in the walls inside C-1’s room. Interviewed staff indicated that the holes on C-1’s wall were repaired consistently and C-1 continued to put more holes on the wall (despite repairs). Interviewed clients indicated the facility does not have holes in the walls. Interviewed clients indicated they do not have any concerns. LPA toured C-1’s room and did not observe any holes on the wall. Interviews and tour do not corroborate allegation.

Refer to LIC 9099C for the continuation of this report

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20240625150454

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: 09/19/2024

NARRATIVE

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Staff did not safeguard client's belongings. It has been alleged that C-1’s door is broken due to other residents breaking into C-1’s room to steal cigarettes, clothing, and furniture. Additionally, it has been alleged that C-1’s belongings have been stolen (phones, debit cards, EBT cards and transit card). Staff interviews revealed that C-1 had a history of destroying facility property (including breaking doors) and history of fabricating stories. Interviewed staff indicated that C-1 carried their phone and cards inside a purse. Interviewed staff indicated that they assisted C-1 in looking for their belongings throughout this facility and did not find C-1’s belongings anywhere else on premises. Interviewed staff indicated they have not received any complaints from other clients pertaining to their belongings being stolen. Interviewed clients indicated that they are not missing any of their personal items and that they have not heard anyone complaining about this matter. Interviews do not corroborate this allegation.

Staff do not provide client with appropriate bed linens. It has been alleged that C-1 "rarely" has bedding to sleep on. Staff interviews revealed that C-1 would remove their bedding all the time for unknown reasons. Interviewed staff indicated they continued to add the bed linens and C-1 continued to remove them. Interviewed staff indicated they have not received any complaints pertaining to this matter. Interviewed clients indicated staff provide them with appropriate bed linens and have no concerns. Interviews do not corroborate this allegation.

Staff do not ensure that the client's room is free of pests. It has been alleged that C-1’s room has holes in the walls that have not been repair which allows cockroaches to enter the room. Interviewed staff indicated they have not received any complaints pertaining to pests (including cockroaches). Interviewed staff indicated that this facility receives pest control services (precautionary measure) on a monthly and as needed basis to prevent pest issues. Interviewed clients indicated they have not seen any pests (including cockroaches) on premises. Interviews and tour do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20240625150454

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: 09/19/2024

NARRATIVE

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Staff did not notify client's responsible party of incident. It has been alleged that facility staff attempted to have C-1 hospitalized (2) times due to C-1’s mental condition and did not notify C-1’s responsible party. Per S-1 interview, C-1’s family member was notified of C-1’s incidents (including hospitalizations). Per S-1, S-1 has not received any complaints/concerns pertaining to this matter. Interview and documentation do not corroborate this allegation.

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, 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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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