198600930-8-11-2023-28-AS-LHIS-CUXHHX-20230822061324

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600930
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:01:18 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
07/20/2023 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230720145148

FACILITY NAME:	VICTORIA RESIDENTIAL CARE HOMES		FACILITY NUMBER:	198600930
ADMINISTRATOR:	JOCELYN MANALO		FACILITY TYPE:	735
ADDRESS:	414 S ABELIAN AVE		TELEPHONE:	(626) 913-4707
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91792
CAPACITY:	4	CENSUS: 3	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	02:11 PM
MET WITH:	Estrella Joaquin, Caregiver		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff spoke to resident in an inappropriate manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequentcomplaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with DSP Estrella Joaquin. Administrator was explained the purpose of the visit telephonically.

The investigation consisted of: On 7/25/2023, a tour of the interior and exterior physical plant was conducted. No staff or resident interviews were conducted today. The following documents were reviewed and obtained: Placement Information/Face Sheet, Physician Report, IPP, caregiver notes, and Individual Needs and Services Plan. NOTE: On 7/26/2023, staff (S1) file documents (staff training), LIC 500 Personnel Report, and resident roster were emailed to LPA. During today's visit, residents (R1- R3) and staff (S1- S3) were interviewed.

***Narrative summary continues next page.***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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-20230720145148

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: VICTORIA RESIDENTIAL CARE HOMES	FACILITY NUMBER: 198600930
	VISIT DATE: 08/11/2023

NARRATIVE

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Allegation: Staff spoke to resident in an inappropriate manner. It is alleged that a staff person told resident (R1) to "shut up" in Spanish, and also stepped on a cat, picked the cat up, and threw it in the bushes. A total of three (3) residents were interviewed. Two (2) of the residents denied the allegation and stated that the person who speaks inappropriate to residents and staff is resident (R1). Resident (R1) stated that staff do not speak to the resident inappropriately. Resident (R1) stated that the person that cussed at them was a former resident. In addition, the resident stated that the facility does not have a cat. The neighbor across the street was the person who threw and mistreated the cat. Resident (R1) also stated that staff (S1) takes pictures of their food. Staff (S1) denied taking pictures of R1's food, but stated that in the past R1 has accused them of taking their P & I money, and now each time monies are disbursed to R1 the staff takes a picture in order to keep proof that the money was given to the resident. All staff interviewed denied speaking to residents/resident (R1) in an inappropriate manner, cussing, or mistreating animals. Staff stated the facility does not have a cat, but a staff did observe a dead cat in the side of the street.

Based on record review, resident (R1) has a diagnosis of intellectual disability with history of story fabrication, and verbal aggressive behaviors. Per Individual Needs and Services Plan, resident (R1) uses profanity, yells at peers and staff, and fabricates stories when frustrated. The findings indicate that resident (R1) was not verbally abused by staff, nor did staff perform animal cruelty to the neighbor's cat.

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 with staff Estrella Joaquin. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

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