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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601235
Report Date: 05/07/2024
Date Signed: 05/07/2024 03:36:45 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
05/02/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240502172942
FACILITY NAME:DOLAN HOMEFACILITY NUMBER:
198601235
ADMINISTRATOR:GURITH TORRES MILIANFACILITY TYPE:
735
ADDRESS:12522 DOLAN AVETELEPHONE:
(562) 923-1172
CITY:DOWNEYSTATE: CAZIP CODE:
90242
CAPACITY:4CENSUS: 4DATE:
05/07/2024
UNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Micaela Rosales, housekeeper TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not prevent client from being physically abused.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and was allowed entry by Staff, Micaela Rosales. Administrator, Gurith Milian, arrived shortly after. The purpose of the visit was explained.

LPA toured the facility and reviewed documents for Client #1. Interviews were held with the administrator, 4 Staff, and 4 Clients.

The investigation revealed the following:
Allegation - Staff did not prevent a client from being physically abused. It is alleged that Client #1’s (C-1) hair was pulled, and the head was moved in a back-and-forth motion. LPA interviewed the administrator and staff who stated there are no abuse occurring at the home. They take good care of the clients and ensure they are clean and well feed. They have not seen any staff or other clients hurting C-1.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
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 2
Control Number 28-AS-20240502172942
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: DOLAN HOME
FACILITY NUMBER: 198601235
VISIT DATE: 05/07/2024
NARRATIVE
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C-1 never indicated anybody pulled his/her hair or shook the head. The house manager stated the police officer came out last week and conducted a welfare check of the client. They did not suspect any physical abuse as alleged. After the visit, Staff asked C-1 if someone pulled the hair. C-1 responded yes but could not specify the person. Staff stated C-1 typically says yes or no and would sometimes change the response when asked again.
LPA interviewed 4 clients. C-1 did not appear to comprehend the questions asked and only provided one word response or repeated the last words LPA said. The other 3 clients like living at the facility and indicated staff treat them well. They have not seen any staff or clients hurting another client.

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.

An exit interview was conducted. A copy of this report along with the appeal rights were provided to the house manager.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2