<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601446
Report Date: 10/17/2023
Date Signed: 10/17/2023 01:33:09 PM

Substantiated


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
03/08/2023 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20230308122117
FACILITY NAME:GATEWAYS NORMANDIE VILLAGE EASTFACILITY NUMBER:
198601446
ADMINISTRATOR:SANDY LONGFACILITY TYPE:
735
ADDRESS:1355 SOUTH HILL STREETTELEPHONE:
(213) 389-5820
CITY:LOS ANGELESSTATE: CAZIP CODE:
90015
CAPACITY:60CENSUS: 51DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Alejandro Rojas, Residential managerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are inappropriately punishing resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
***This report serves as an amendment and supersedes the original complaint investigation report created on 03/16/23. The finding of the allegation was changed to Substantiated. ***

Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegations listed above today. During today’s visit, LPA met with Residential Manager, Alejandro Rojas and explained the purpose of today's visit.

On 03/16/23, LPA Tao conducted an unannounced initial investigation visit at the facility. On 10/17/23, LPA conducted an unannounced subsequent investigation visit.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #5 (S5); interviews of clients from client#1 (C1) through client #6 (C6); reviewed client#1’s record reviews, and conducted a facility tour. (-continued in LIC 9099C-)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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 6
Control Number 28-AS-20230308122117
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: GATEWAYS NORMANDIE VILLAGE EAST
FACILITY NUMBER: 198601446
VISIT DATE: 10/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***This report serves as an amendment and supersedes the original complaint investigation report created on 03/16/23. The finding of the allegation was changed to Substantiated. ***

LPA obtained copies of the staff and client rosters, client#1’s files and documents with relevant information.
In regard of allegation, “staff are inappropriately punishing resident,” it was alleged that client#1 was given a one-week restriction and denied client of going out in the community to have sunlight and fresh air for one week. The investigation revealed the following: Per client interview of client#1 (C1), C1 stated staff put client on a one-week restriction due to staff found adult pornography pictures in C1’s room. As a result, C1 was on a one-week restriction. Five (5) out of six (6) clients interviewed could not corroborate the allegation. Per staff interviews, four (4) out of five (5) staff could not corroborate the allegation. One (1) out of five (5) staff corroborated the allegation. Staff interviews revealed that facility violated client’s personal right. File review revealed C1 violated facility rules which clients process pornographic material of any nature was not allowed in the facility. Staff stated C1 admitted those porn pictures were belonged to C1 when pictures were found in C1’s room. C1 was notified of this house rule upon admission. Client needed to stay in-house and not able to leave the facility unless for essential medical appointment for one-week restriction. Therefore, staff inappropriately punished client and violated client’s personal right.

Based on LPA's observations, record reviews and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D.

An exit interview was conducted with Residential Manager, Alejandro Rojas. A hard copy of this report and appeal right were provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/08/2023 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20230308122117

FACILITY NAME:GATEWAYS NORMANDIE VILLAGE EASTFACILITY NUMBER:
198601446
ADMINISTRATOR:SANDY LONGFACILITY TYPE:
735
ADDRESS:1355 SOUTH HILL STREETTELEPHONE:
(213) 389-5820
CITY:LOS ANGELESSTATE: CAZIP CODE:
90015
CAPACITY:60CENSUS: 51DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Alejandro Rojas, Residential managerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are retaliating against resident for filing a complaint.
Staff refuse to provide resident with his records.
Staff are mentally abusing resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
***This report serves as an amendment and supersedes the original complaint investigation report created on 03/16/23. The findings of the allegations remained as unsubstantiated. ***

Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegations listed above today. During today’s visit, LPA met with Residential Manager, Alejandro Rojas and explained the purpose of today's visit.

On 03/16/23, LPA Tao conducted an unannounced initial investigation visit at the facility. On 10/17/23, LPA conducted an unannounced subsequent investigation visit.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #5 (S5); interviews of clients from client#1 (C1) through client #6 (C6); reviewed client#1’s record reviews, and conducted a facility tour. (-continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20230308122117
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: GATEWAYS NORMANDIE VILLAGE EAST
FACILITY NUMBER: 198601446
VISIT DATE: 10/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***This report serves as an amendment and supersedes the original complaint investigation report created on 03/16/23. The findings of the allegations remained as unsubstantiated. ***

LPA obtained copies of the staff and client rosters, client#1’s files and documents with relevant information.
In regard of allegation, “staff are retaliating against resident for filing a complaint,” it was alleged that client#1 was being harassed for filing complaints.

The investigation revealed the following: Per client interview of client#1 (C1), C1 stated client was harassed by other clients for filing complaints, not harassed by staff. Five (5) out of six (6) clients interviewed could not corroborate the allegation. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed facility had a policy to ensure clients had right to file complaints. Per file reviews, staff had annual in-service training on clients’ right. Therefore, there is not preponderance evidence to prove the facility retaliating against client for filing a complaint.

In regard of allegation, “staff refuse to provide resident with his records,” it was alleged that client#1 requested to review client#1’s files/chart and staff had not provided the chart to client for review.
The investigation revealed the following: Per client interview of client#1 (C1), client stated staff had not provide C1’s records to C1’s review since requested. Five (5) out of six (6) clients interviewed stated they could review their files if they requested. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed facility would provide client’s file for clients review if requested. Staff stated C1 said client did not want to see client’s record after requested for file review. Therefore, staff did not refuse to provide client with client’s records for review.

In regard of allegation, “staff are mentally abusing resident,” it was alleged that client#1 felt client was being mentally abused because client asked for a transfer and client felt staff would not give client a referral ahead of time before discharged. Per client interview of client#1 (C1), client clarified that client felt being mentally abused by staff because client was not notified about the transfer progress, and it took long time to process C1’s transfer request. Five (5) out of six (6) clients interviewed could not corroborate the allegation. All five (5) staff who were interviewed denied the allegation. Staff interviews revealed staff had notified client of the transfer progress. Per file review, facility had held meetings with C1 and documented C1’s transfer progress in client’s chart/notes. Since client’s placement needs to go through the court and different State departments, the process takes time. Thus, there is not preponderance evidence to prove the facility staff was mentally abusing clients. (-continued in LIC 9099C-)
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20230308122117
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: GATEWAYS NORMANDIE VILLAGE EAST
FACILITY NUMBER: 198601446
VISIT DATE: 10/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
***This report serves as an amendment and supersedes the original complaint investigation report created on 03/16/23. The findings of the allegations remained as unsubstantiated. ***

Based on the information obtained during the investigation, interviews with staff, clients, review of client files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

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

An exit interview was conducted with Alejandro Rojas and findings were discussed. A copy this report was provided at the time of visit.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 28-AS-20230308122117
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: GATEWAYS NORMANDIE VILLAGE EAST
FACILITY NUMBER: 198601446
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/19/2023
Section Cited
CCR
80072(a)(6)
1
2
3
4
5
6
7
Personal Rights (a)(6) Each client shall have personal rights which include.. To leave or depart the facility at any time.
This requirement was not met by evidence of:

Per interviews conducted, staff put on a one-week restriction on client which client
1
2
3
4
5
6
7
Licensee agreed to provide an updated house rules regarding the one-week restriction to Licensing for review and approval by the due date.
8
9
10
11
12
13
14
needed to stay in-house and not able to leave the facility unless for essential medical appointment for one-week. Based on interviews and observation, the Licensee did not comply with the section cited above which poses 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: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6