198601341-10-13-2022-28-AS-MVAO-CL2UHA-20221110143536

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601341
Report Date: 10/13/2022
Date Signed: 10/13/2022 04:21:45 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
06/15/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220615153647

FACILITY NAME:	CASA RIO HONDO		FACILITY NUMBER:	198601341
ADMINISTRATOR:	PEDRO TRAVIESO		FACILITY TYPE:	735
ADDRESS:	11010 RIO HONDO DRIVE		TELEPHONE:	(562) 928-2807
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90241
CAPACITY:	4	CENSUS: 4	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Licensee Yusimi Travieso		TIME COMPLETED:	04:36 PM

ALLEGATION(S):

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Resident was physically abused.

INVESTIGATION FINDINGS:

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On 10/13/22 at 9:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste attempted to conduct an unannounced subsequent visit to deliver a final report based on the complaint investigation conducted by the Investigations Branch (IB). Upon arrival no one was at the facility and LPA attempted to call administrator and the facility with no success. At 4:00 p.m., LPA returned to the facility, met with Licensee Yusimi Travieso and explained the purpose of the visit.

The investigation consisted of the following: On 6/17/2022, an initial 10-day complaint visit was conducted by LPA Baptiste. During the visit LPA obtained a copy of the Staff/Resident roster, C1-C4 Face sheet, C1-C4 LIC 602, C1-C4 Physical assessment, and conducted a health and safety check. During file review LPA obtained SIRs from 10/13/20 to 6/7/22 and forwarded them to IB investigator as it relates to the investigation. The IB investigator conducted resident and staff interviews. Investigator obtained C1 IPP and attempted to obtain hospital records and police records for C1 but has received no response at this time.

***See LIC 9099C for continuation of report.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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-20220615153647

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: CASA RIO HONDO	FACILITY NUMBER: 198601341
	VISIT DATE: 10/13/2022

NARRATIVE

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Investigation revealed the following: Allegation "Resident was physically abused." Based on Investigations Branch (IB) findings: Client (C1) has a history of self-inflicted injuries to themself and others. The behaviors are believed to be in correlation with C1’s medical diagnosis. C1’s behaviors consist of the destruction of property (furniture/ household items) using physical force, and self-inflicted injuries to self and/or others requiring either, first aid or medical care. Interviews with C1’s family members revealed while C1 was living at home, C1 inflicted injuries to themself and family members while in care. Due to C1’s behaviors, C1's family decided they were unable to care for C1. C1’s family members indicated that they are satisfied with C1’s care and have seen improvement in C1’s aggressive behaviors since being at the facility. Interviews with behavior therapists indicated that they witnessed C1 having tantrums and self-inflicting injuries by picking, pinching, and hitting during a therapy session. A review of C1’s IPP noted that they working to reduce C1’s self-injurious behaviors from every week to once a month. The facility is working in conjunction with a Placement Agency, and a behavioral therapist to mediate C1’s behavior.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report was provided to Licensee Yusimi Travieso.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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