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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601304
Report Date: 09/12/2022
Date Signed: 09/12/2022 11:14:27 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
09/17/2021 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210917101158
FACILITY NAME:BAILEY CARE HOME #4FACILITY NUMBER:
198601304
ADMINISTRATOR:SHAWN L. BAILEYFACILITY TYPE:
735
ADDRESS:10413 VULTEE AVE.TELEPHONE:
(562) 622-0806
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:4CENSUS: 3DATE:
09/12/2022
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Shawn Bailey (Administrator)TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Resident was physically and sexually assaulted while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long delivered complaint findings to the facility. Upon arrival, LPA met with Shawn Bailey (Administrator) and explained the purpose of the visit.

On the initial visit conducted on 09/17/21, LPA Flores conducted a health and safety check that consisted of the following: LPA tour 4 client bedrooms, kitchen, living room, 3 client bathrooms, and backyard. LPA observed the following: Client's bedrooms have the required bedding and furniture. Bedroom #3 has electrical output case broken, and a floor tile about 2 feet long is loose at the entrance of the room. LPA tested water temperature as follow bathroom #1 tested at 117.1 degrees F, bathroom #2 tested at 113.7 degrees F, bathroom's toilet was observed without a lid, bathroom #3 116.5 degrees F which is within the required 105 to 120 degrees F. Facility has sufficient food 2 days of perishables and 7 days of non perishables. Knives and cleaning supplies were observed locked on a cabinet above washer and dryer area. Fire sprinkle system was observed. Medication was observed in office and under lock. Fire extinguisher observed and current.
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: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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-20210917101158
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: BAILEY CARE HOME #4
FACILITY NUMBER: 198601304
VISIT DATE: 09/12/2022
NARRATIVE
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In regards to the allegation: Resident was physically and sexually assaulted while in care. The department reviewed local law enforcement records and (client #1) medical records, interviewed 9 Staff and 2 Clients. Alleged victim/Client #1 made inconsistent statements to law enforcement, hospital social worker and facility staff and client #1 disclosed to another client that the (date of incident) incident did not occur and client #1 made up the allegation. Client #1 indicated that when the sexual assault happened, client #1's catheter was removed and reinserted, but when client #1 was physically examined by PIH Health Hospital , the catheter was properly in place with no evidence of trauma. Staff and another client interviewed have no knowledge of any sexual abuse or any inappropriate behavior by staff #9 (Alleged Abuser). Medical records dated 09/15/21 indicated patient/client #1 was well-appearing, had stable vital signs and there was no obvious external trauma. Law enforcement records indicated a report was taken by law enforcement and the case was closed without further investigation. The investigation did not provide sufficient evidence to support that client #1 was physically and/or sexually assaulted.

Based on the departments record review and interviews, the investigation revealed: 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 Shawn Bailey 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: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2