198600654-9-4-2021-28-AS-MVAO-C74PSJ-20210922113424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600654
Report Date: 08/20/2021
Date Signed: 09/04/2021 02:57:20 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
12/30/2019 and conducted by Evaluator Pat Rivas

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191230154744

FACILITY NAME:	CONTINENTAL GUEST HOME		FACILITY NUMBER:	198600654
ADMINISTRATOR:	RUBERTO BALUYOT		FACILITY TYPE:	735
ADDRESS:	15482 PASTRANA DRIVE		TELEPHONE:	(714) 522-3013
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 3	DATE:	08/20/2021
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Ruberto Baluyot, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff touched resident inappropriately.
Staff made inappropriate comments towards resident.
Staff throws water on resident's face.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) P Rivas conducted a follow- up complaint visit render findings on the above allegations.Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) to implement mitigation measures today's complaint investigation was conducted telephonically with the facility administrator .

Investigation consisted of the following: Review of four out of four resident files, interview with two of four residents. Interview with three staff, including administrator, interview with two family members. Two out of Four residents were non verbal and were not able to provide information LPA interviewed three staff including Administrator. On 01/09/2020 one interview was conducted with verbal resident . On 01/16/2020 interview with second resident was completed

In reference the allegation That staff touched resident inappropriately.
The investigation revealed: Three of Three staff interviewed denied the allegation and denied witnessing any (cont)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Pat Rivas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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-20191230154744

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: CONTINENTAL GUEST HOME	FACILITY NUMBER: 198600654
	VISIT DATE: 08/20/2021

NARRATIVE

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incidents. Two of two residents interviewed denied having been inappropriately touched or witnessing any inappropriate touch. One of the residents interviewed was the alleged victim. Two family members interviewed had not heard of allegation.

In reference to the allegation that staff made inappropriate comments towards residents.
The investigation revealed; Three of three staff interviewed denied the allegation and denied witnessing anyone using inappropriate comments. Two of two residents interviewed denied having been told inappropriate comments or hearing any inappropriate comments towards residents.. One of the residents interviewed was the alleged victim. Two witnesses interviewed had not heard of allegation.

In reference to the allegation that staff throws water on residents faces.
The investigation revealed; Three of three staff interviewed denied the allegation and denied witnessing any staff throwing water at residents faces. Two of two residents interviewed denied having water being thrown at their faces or seen staff throw water at their faces. One witness interviewed denied knowledge of the allegation. One of two witnesses interviewed did not witness incident but had been advised “water was thrown on client#1’s face” but no other details were provided.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, appeal rights issued.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Pat Rivas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC9099 (FAS) - (06/04)

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