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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600454
Report Date: 04/02/2025
Date Signed: 04/02/2025 01:40:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/27/2025 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250327152340
FACILITY NAME:OLIVE'S HOMEFACILITY NUMBER:
198600454
ADMINISTRATOR:HARRIS, JOFACILITY TYPE:
735
ADDRESS:20020 BROADACRES AVENUETELEPHONE:
(310) 604-6010
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:6CENSUS: 4DATE:
04/02/2025
UNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Rizalie BondocTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Adult in home slaps client.
INVESTIGATION FINDINGS:
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On 4/2/25, at 9:12am, the department conducted an initial complaint visit to the facility and was greeted by Rizalie Bondoc, DSP, and later by Jaime Duran, Administrator. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and clients, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: The Department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S3) and clients (C1-C3) from 10:00am-1:30pm. The department received the following: Client Roster (Dated:1/15/2025), Staff Roster (Dated: 08/05/2019), Physicians Reports (Dated: 6/12/2024), Individual Program Plan (Dated: 02/22/2024, 11/30/2023, 01/10/2024), In-Service Staff Trainings (Dated: 1/08/2025, 02/21/2025, 03/24/2025), and Face Sheets (Dated: 2022) from the facility.

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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
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 11-AS-20250327152340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: OLIVE'S HOME
FACILITY NUMBER: 198600454
VISIT DATE: 04/02/2025
NARRATIVE
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The investigation revealed the following: Allegation-Adult in home slaps client.

The details of the complaint alleged that the facility staff slaps clients in care. On 4/2/25, from 10:00am-1:30pm, the department interviewed staff (S1-S3) and clients (C1-C3) regarding the allegation. 3 of 3 staff denied the allegation that the Adult in home slaps client. All staff (S1-S3) stated that no one in the facility slaps or abuses any of the clients in anyway. Staff (S1) stated that there was a misunderstanding with a visitor at the facility recently that misinterpreted an outburst by a client in care with behavior problems and a history of fabrication. S1 further stated that all staff get along very well with all the clients in care and that they have never witnessed or heard that the staff slaps, mistreats, or handles any client in care roughly.

The Department interviewed clients (C1-C3) about the allegation and 3 of 3 clients that were interviewed denied the allegation that an Adult in home slaps client. All clients (3 of 3) stated that they have never been slapped or mistreated by the staff and they are happy with the care and supervision they are receiving from the facility.

The Department reviewed In-Service Staff Trainings (Dated: 1/08/2025, 02/21/2025, 03/24/2025) and observed that the staff has training in Non-Punishment Procedures, Personal Rights, Management of Aggression, Pro-Act (Professional Assault Crisis Training) and Your Legal Duty (Reporting Elder and Dependent Adult Abuse). Additionally, the department reviewed Individual Program Plans (Dated: 02/22/2024, 11/30/2023, 01/10/2024) for all clients and observed that the certain clients have a history of attention seeking behavior, emotional outbursts, and fabricating stories.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Adult in home slaps client. 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.

No citations were issued.

An exit interview was conducted with Jaime Duran, Administrator, and a hard copy of this Complaint Investigation Report was provided.

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SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2