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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600419
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:57:42 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
10/19/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221019161133
FACILITY NAME:GEHM HOME IIFACILITY NUMBER:
198600419
ADMINISTRATOR:HERNANDEZ, MARY ANNFACILITY TYPE:
735
ADDRESS:1203 BREA CANYON CUT-OFF ROADTELEPHONE:
(909) 595-5775
CITY:ROWLAND HEIGHTSSTATE: CAZIP CODE:
91748
CAPACITY:4CENSUS: 4DATE:
10/25/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Araceli Aguilar TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility staff pulled resident's hair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint investigation to investigate the above allegation. LPA met with DSP Araceli Aguilar and explained the reason of the visit.

The investigation consisted of the following: LPA interviewed four clients (C1-C4) and two staff (S1-S2) in the facility and administrator and one staff (S3) on the phone. LPA also obtained documents for C1's face sheet, placement information, Individual Program Plan (IPP), Facility Annual Report and Annual Behaviora Progress Report and Support Plan

The investigation reveled of the following: In regards to the allegation " Facility staff pulled resident's hair." LPA interviewed all four clients and all denied the allegation and stated that all the staff are nice in the facility. LPA interviewed C1 and reported staff touched hair by accident while C1 was in shower and staff was soft touching and no hurt at all. LPA interviewed staff and all denied the allegation and reported they never witnessed any staff pulled client's hair in the facility. (See LIC 9099C for continuation)

Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
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 2
Control Number 28-AS-20221019161133
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: GEHM HOME II
FACILITY NUMBER: 198600419
VISIT DATE: 10/25/2022
NARRATIVE
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LPA also interviewed administrator and reported police also came and investigated and there's no evidence of crime occurrence and no follow up necessary.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported 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 allegation is UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided to DSP Araceli Aguilar.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2