198601273-9-2-2025-28-AS-FFIS-DLP34F-20250919175500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601273
Report Date: 09/02/2025
Date Signed: 09/02/2025 10:11:36 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/25/2025 and conducted by Evaluator Luis DeLeon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250725081009

FACILITY NAME:	EASTER SEALS SOUTHERN CALIFORNIA FACULTY HOME		FACILITY NUMBER:	198601273
ADMINISTRATOR:	NJOROGE, PRISCILLAH		FACILITY TYPE:	735
ADDRESS:	11644 FACULTY DR		TELEPHONE:	(562) 402-0252
CITY:	NORWALK	STATE: CA	ZIP CODE:	90650
CAPACITY:	3	CENSUS: 2	DATE:	09/02/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	DSP Lorena Vasquez		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff do not follow proper food service sanitation practices

INVESTIGATION FINDINGS:

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*** This amended LIC-9099 report supersedes the LIC-9099 generated on 7/31/2025 ***
This revised copy corrects Title 22 regulation text cited on the LIC-9099D.
The findings remain the same - Substantiated.

Licensing Program Analysts (LPAs) Elena Mallett & Luis De Leon conducted a subsequent unannounced visit to correct citation language on previous complaint investigation report for the allegation listed above. LPAs met with DSP Lorena Vasquez and explained the reason for today’s visit. DSP Lorena Vasquez contacted Administrator Armando Flores and Director Daniela Tilles to inform of LPAs’ visit. Director Daniela Tilles authorized DSP Lorena Vasquez to sign the corrected report.
On 9/2/2025, clients were observed in the living and dining room eating breakfast and watching TV. The LPAs toured common facility areas and observed no health and safety risks.

Report continues on page LIC 9099C...

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Luis DeLeon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

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-20250725081009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA FACULTY HOME	FACILITY NUMBER: 198601273
	VISIT DATE: 09/02/2025

NARRATIVE

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The investigation consisted of the following: On today’s visit, LPA De Leon toured the physical plant with DSP Loren Vasquez and obtained the current client and staff roster. LPA obtained the following documents for clients C1 and C2: Face sheet, physician’s reports, nutritional assessment, facility physician’s reports for clients C1 and C2.

Regarding allegation: Staff do not follow proper food service sanitation practices.
It is alleged that licensee is storing urine specimen from clients in a garage refrigerator where food is also stored for client’s consumption. The garage refrigerator is also used by staff to keep their daily meals. The investigation revealed the following: Interview with two (2) out of two (2) staff members confirmed that garage refrigerator was used one time only, since last February 2025, to store urine specimen from a client in care. Director Daniela Tilles stated that medical support started coming to the facility since February 2025 to attend client’s medical needs at home which included lab work. Director stated that one incident occurred where nurse left specimen for the lab to pick up. The specimen was picked up on the same day and it only occurred one time. LPA observed that garage/back refrigerator has a posted sign which states that “Only use the extra/back refrigerator for personal food item.” Urine specimen is not considered a food item, and it may pose a risk to contaminate food stored in the refrigerator. LPA’s attempt to interview clients was unsuccessful. Based upon investigation, staff interviews, and LPA observations, licensee is not properly following food sanitation practices. The food may risk contamination, not be safe to meet the needs of the clients.

Based on LPA observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, are being cited on the attached LIC 9099D.

Exit interview held with DSP Lorena Vasquez. A copy of the LIC-9099, LIC-9099C and LIC-9099D reports and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Luis DeLeon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250725081009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA FACULTY HOME	FACILITY NUMBER: 198601273
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/02/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 08/08/2025 Section Cited CCR 80076(a)(1)	1 2 3 4 5 6 7	(a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall write a plan to eliminate the risk of food contamination for storing client's food. The plans must be sent to CCLD by the POC due date.
	8 9 10 11 12 13 14	Based on observation and interview, the licensee did not comply with the section cited above in safely maintaining client's food in garage refrigerator which also was used to store urine specimen which poses/posed a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Luis DeLeon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2025

LIC9099 (FAS) - (06/04)

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