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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600581
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:39:54 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
11/26/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241126152459
FACILITY NAME:HOMES FOR LIFE FOUNDATION-HFL CEDAR STREET HOMEFACILITY NUMBER:
198600581
ADMINISTRATOR:VIDA ANDRADEFACILITY TYPE:
735
ADDRESS:11401 BLOOMFIELD, BLDG.305-307TELEPHONE:
(562) 207-9660
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:38CENSUS: 30DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator Vida AndradeTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not treat resident with dignity and respect.
Staff do not ensure a safe enviroment for residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villaobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with administrator Vida Andrade and the purpose of the visit was discussed.

LPA conducted the following: Interviewed Staff #1-#5 (S1-S5), Interviewed client #1-#5 (C1-C5), clients #6-7 (C6-C7) are no longer living in the facility and were not available for interview, LPA collected copies of the staff and client roster, LPA also collected copies of documents from S1's file. The investigation revealed the following:

In regards to the allegation: Staff did not treat resident with dignity and respect, it is alleged that S1 threw water at C6 and C7 during a physical altercation between the clients to stop it. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Clients interviewed could not corroborate the allegation....

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 2
Control Number 28-AS-20241126152459
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: HOMES FOR LIFE FOUNDATION-HFL CEDAR STREET HOME
FACILITY NUMBER: 198600581
VISIT DATE: 12/05/2024
NARRATIVE
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S1 denied throwing water at any clients in care. S1 stated there was an altercation between C6 and C7 on 2/14/24 but denies throwing water directly at any clients. S1 stated to have been holding a water cup and threw the water down to the floor to then attempt to break up the fight. It was not thrown at the clients. C6 and C7 are no longer clients in the facility and LPA was unable to interview them. Staff and clients interviewed were not able to corroborate the allegations and stated to have never seen S1 throw anything at clients in care. There are no documents observed on file showing staff to throw anything at clients. Incident report on file states the staff used de-escalations methods to redirect the clients. Based on observations, file review and interviews; 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.

In regards to the allegation: Staff do not ensure a safe environment for residents in care. it is alleged that there have been multiple instances of homeless individuals breaking into the facility to use the showers in the residents rooms. (5) of (5) Staff interviewed denied the allegation. (5) of (5) Clients interviewed could not corroborate the allegation. Staff interviewed stated there has been one incident of something similar happening. LPA was informed and also observed that all restrooms in the facility are common restrooms and are not attached to any client rooms. Interviews with staff stated there was an intruder who entered the facility to use the common restroom on 10/10/24. The staff immediately approached the door that morning once they were aware someone entered the building to use the restroom. The staff on shift realized the person inside was not a client of the facility. The staff began to demand the intruder leave the building. Interviews explained that there are (2) Staff on each overnight shift and more arrive early morning. On this day they worked together to make sure the clients were safe and the intruder was removed without problems. Staff interviewed also added that the intruder left the building before police arrived and staff continued conducting room checks for all clients afterwards to ensure their safety as they regularly do. Clients interviewed stated they felt safe in the facility and believe the staff are active in making sure the facility is a safe environment for them. Based on observations, file review and interviews; 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 and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2