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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600583
Report Date: 06/04/2025
Date Signed: 06/05/2025 04:15:46 PM

Substantiated


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
05/23/2025 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250523123912
FACILITY NAME:DE LEON HOME - BELLFLOWERFACILITY NUMBER:
198600583
ADMINISTRATOR:MAUREEN DELEONFACILITY TYPE:
735
ADDRESS:10240 VAN RUITENTELEPHONE:
(562) 920-3241
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:4CENSUS: 4DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rana Chapkhaneh-CaregiverTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility allowed an uncleared staff to provide care and supervision to residents.
Facility did not ensure that staff completed CPR training.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Rana Chapkhaneh and explained the purpose of today's visit.

The investigation consisted of the following:
During initial visit 5/27/25 LPA interviewed 2 Staff (S1-S2) and 7 staff files. On 5/29/25 LPA reviewed Guardian website to verify fingerprint clearance of S3. During todays visit LPA delivered findings for the above allegations.

(continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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 4
Control Number 28-AS-20250523123912
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: DE LEON HOME - BELLFLOWER
FACILITY NUMBER: 198600583
VISIT DATE: 06/04/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Facility allowed an uncleared staff to provide care and supervision to residents.
It is alleged that facility has allowed S1 to provide care and supervision to clients without obtaining the required fingerprint clearance. During interview with S1, it was confirmed that S3 worked for facility in 2024 and was not fingerprint cleared and that S3 has not worked at facility since November 2024. S1 stated that S3 did get fingerprinted, and the process was started but never completed. S1 stated that they are aware that they should have verified clearance prior to allowing S3 to work providing care and supervision. LPA attempted to review S5’s file, however, file was not at facility (this will be cited in a separated case management visit/report). LPA checked Guardian (a tool used to verify fingerprint clearance) and the notation of incomplete application was observed, application started on 5/7/24 and closed because incomplete on 8/5/24, therefore, fingerprint clearance was never approved. (Substantiated- An immediate civil penalty of $500 is hereby assessed with citation)

Allegation: Facility did not ensure that staff completed CPR training.
It is alleged that S1 along with other staff at facility have not conducted the required First-Aid or CPR training. LPA reviewed 7 staff files and 3 out of the 7 staff files were missing their CPR/First-Aid Certificates. During interview with S1 it was explained that S4 does not have a valid CPR/First-Aid certificate and is currently employed with facility providing care and supervision to clients. (Substantiated)

Based on LPAs observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D's. Civil penalties were assessed. An exit Interview was conducted and copy of the report, LIC421, and Appeal Rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 28-AS-20250523123912
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: DE LEON HOME - BELLFLOWER
FACILITY NUMBER: 198600583
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/06/2025
Section Cited
CCR
80065(i)(1)
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80065 Personnel Requirements (i) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations.
This requirement was not met as evidence by:
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Administrator/Licensee to develop a plan on how facility will ensure that each staff will be fully fingerprint cleared prior to employment or initial presence in the facility and email this plan to LPA by POC due date of 6/6/25.
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During interview with S1 it was confirmed that S3 did not complete the fingerprint process prior to employment at facility in which S3 provided care and supervision to clients, additionally LPA reviewed Guardian and observed the application was incomplete and closed due to being incomplete on 8/5/24.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20250523123912
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: DE LEON HOME - BELLFLOWER
FACILITY NUMBER: 198600583
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/18/2025
Section Cited
CCR
80075(f)
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80075 Health Related Services (f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement was not met as evidence by:
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Administrator/Licensee to provide LPA with a valid First-Aid certificate for S3 by POC due date, review the regulation and complete the POC form LIC9098 which will indicate that the regulation was reviewed and moving forward facility will ensure all staff have a valid certificate in file moving forward.
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LPA reviewed staff files and 3 files were missing their CPR/First-Aid certificates. Converstation with S1 revealed that S4 does not have a valid CPR or First-Aid certificate and documentation for S1 First-Aid certificate was not in file.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4