198600706-5-23-2025-28-AS-RORN-DH5ML9-20250529094157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600706
Report Date: 05/23/2025
Date Signed: 05/23/2025 02:32:25 PM

Unsubstantiated

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
05/07/2025 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250507095558

FACILITY NAME:	CATHERINE'S HOMES, INC. (FLOWER ST)		FACILITY NUMBER:	198600706
ADMINISTRATOR:	MICHAEL SAN DIEGO		FACILITY TYPE:	735
ADDRESS:	9130 FLOWER STREET		TELEPHONE:	(562) 263-9866
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	5	CENSUS: 4	DATE:	05/23/2025
		UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	Mellanie G Aikman - Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff are physically harming resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted a subsequent visit to deliver complaint investigation findings on the above mentioned allegation. LPA met with Administrator Mellanie Aikman and explained the purpose of the visit.

Investigation consisted of the following:

During the initial visit conducted on 5/12/2025 LPA obtained copies of Special Incident Reports(SIR's), Client #1 (C1) Facesheet, Conservator Apporval, Individual Service Plan and other relavent documents within C1's file, LPA interviewed 4 staff, 1 client. On 5/22/25 LPA interviewed 3 witnesses (W1-W3) via phone call and during todays visit 5/23 LPA interviewed C4.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

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-20250507095558

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: CATHERINE'S HOMES, INC. (FLOWER ST)	FACILITY NUMBER: 198600706
	VISIT DATE: 05/23/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Staff are physically harming resident in care.
It is alleged that facility staff have injured C1 by pushing C1 off a building. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that they have never hurt any of the clients and C1 has history of fabrication with allegations of staff harming C1 and C1's significant other (when C1 does not have a significant other). LPA interviewed 2 clients and both clients denied the above allegation. C1 was not available for interview. C3 cannot communicate verbally, therefore, no interview was completed. LPA interviewed 3 witnesses and both denied the above allegation and stated that C1 has a history of making false allegations and stated that C1 was hospitalized on 5/3/25 where accusations of facility staff pushing C1 off a building were made and confirmed that C1 did not have any injuries or bruising that would corroborate with the allegation. LPA W3 that C1 did not have any injuries, fractures or bruising while at hospital on 5/3/25 that would corroborate with the allegation. LPA reviewed C1's Individual Service Plan and Quarterly Progress Notes and there were notes of false allegations within file. LPA reviewed Hospital Discharge paperwork dated 5/3/25 and it was noted that C1 did not have any injuries post alleged fall. LPA observed interactions with clients and staff during both visits and clients appeared to be in good spirits, friendly with staff and did not appear to be withdrawn or afraid of staff.

Based on statements and interviews conducted with staff/clients/witnesses, review of client files and LPAs observations, there was not enough supportive evidence to concur with the reported allegation. 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 held, and a copy of this report will be emailed to Mellanie Aikman.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025

LIC9099 (FAS) - (06/04)

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