198600460-5-6-2022-28-AS-WSHO-CF6VZX-20220607165327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600460
Report Date: 05/06/2022
Date Signed: 05/06/2022 02:23:42 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
04/15/2022 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220415154520

FACILITY NAME:	MONTEBELLO HOME		FACILITY NUMBER:	198600460
ADMINISTRATOR:	OBSTACULO, CRISTINA		FACILITY TYPE:	735
ADDRESS:	740 SOUTH MONTEBELLO BLVD.		TELEPHONE:	(323) 477-1543
CITY:	MONTEBELLO	STATE: CA	ZIP CODE:	90640
CAPACITY:	6	CENSUS: 6	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Staff S1		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff spank resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff S1 and explained the reason for the visit.
The purpose of the visit is to deliver the findings from the original complaint dated 04/15/2022.
The initial visit was conducted on 04/19/2022 and included the following:
From 8:05 AM to 8:50 AM Client's 2-5 were interviewed. Attempts were made to interview Client's 1 and 6 who were non-verbal and didn't respond to questioning.
From 8:55 AM to 9:55 AM S1-S3 and Administrator were interviewed.
Client 1's file was reviewed.
Physician's Report, IPP, Emergency ID Page and Psychological Evaluation to be submitted to Licensing.
Resident and Staff Roster to be submitted.
In regards to the allegation Staff spank resident, based on information and interviews conducted with staff, clients, Regional Center Representative and family member of Client C 1 it was revealed by family member of Client C 1 that law enforcement had come to the family home on the weekend and that Client C 1 stated

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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-20220415154520

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: MONTEBELLO HOME	FACILITY NUMBER: 198600460
	VISIT DATE: 05/06/2022

NARRATIVE

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that he didn't get spanked.
Interview with Regional Center Representative who stated that she was not even concerned. Stated Regional Center did not investigate.
Stated she has been to the home numerous times and feels very good about the staff and home and has not had any problems there over the years.
Interviews with 4 of 6 clients interviewed who stated that staff are nice and have not heard them yell at or hit staff.
Also stated that staff treat Client C 1 well and it is Client C1 who fights with another client.
The other 2 clients are non-verbal and didn't respond to questioning.
Staff interviewed stated that Client C 1 will start fights with other clients.
Also stated that Client C 1 uses a pull-up and does it himself.
Stated that he has not been spanked and if any accident will be cleaned right away and they will help in assisting with showering daily.

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.
Exit interview conducted.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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