198600717-6-9-2023-28-AS-FFIS-CSN3JV-20230609181808

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600717
Report Date: 06/09/2023
Date Signed: 06/09/2023 11:17:42 AM

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
06/02/2023 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230602125457

FACILITY NAME:	FRANCISQUITO HOMES		FACILITY NUMBER:	198600717
ADMINISTRATOR:	TUASON, CYNTHIA		FACILITY TYPE:	735
ADDRESS:	15704 EAST FRANCISQUITO AVENUE		TELEPHONE:	(626) 918-6712
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	6	CENSUS: 5	DATE:	06/09/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Lellanie De Guzman (Direct Support Professional)		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff hit resident causing injury.
Facility staff yelled at resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Lellanie De Guzman (Direct Support Professional) and explained the purpose of the visit.

During today's visit, LPA obtained a copy of the Staff Schedule/Client Roster and interview Staff #1 and #2 in the dining area. LPA also interviewed Clients #5 via telephone and attempted to interview Clients #1, #2, #3 and #4.

In regards to the allegation: Facility staff hit resident causing injury. 2 of 2 Staff interviewed denied ever hitting or causing injury to a Client and never witnessed other Staff hit or cause injury to Clients. Interview with 1 of 1 Client indicate Staff did not hit or cause injury to them and did not witness Staff hit or cause injury to other Clients. Continue to LIC9099C.....

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

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-20230602125457

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: FRANCISQUITO HOMES	FACILITY NUMBER: 198600717
	VISIT DATE: 06/09/2023

NARRATIVE

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In regards to the allegation: Facility staff yelled at resident. 2 of 2 Staff interviewed denied ever yelling at a Client and never witnessed other Staff yell at Clients. Interview with 1 of 1 Client indicate Staff did not yell at them and did not witness Staff yell at other Clients.

Based on LPA's interviews, the investigation revealed: Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted with Lellanie De Guzman (Direct Support Professional) and a copy of this report provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2023

LIC9099 (FAS) - (06/04)

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