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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601499
Report Date: 09/24/2021
Date Signed: 10/26/2021 02:40:43 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
11/19/2020 and conducted by Evaluator Nina Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20201119103705
FACILITY NAME:SIERRA VISTAFACILITY NUMBER:
198601499
ADMINISTRATOR:KIMBERLY ISAACFACILITY TYPE:
735
ADDRESS:670 W. HOWARD STREETTELEPHONE:
(626) 398-1530
CITY:PASADENASTATE: CAZIP CODE:
91103
CAPACITY:6CENSUS: 3DATE:
09/24/2021
ANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Nancy ParkerTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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9
Staff verbally abusing residents
INVESTIGATION FINDINGS:
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On 10/26/2021 Licensing Program Analyst (LPA) Nina Galarza has amended the report to reflect client number corrected on 9099 and 9099C. LPA Galarza delivered the report to Patria Mendez on 10/26/2021.

On 9/24/2021 Licensing Program Analysts (LPAs) Nina Galarza and Nune Margaryan conducted a subsequent complaint visit for the allegation listed above, initially reported on 11/19/2020. LPAs met with assistant administrator Nancy Parker and stated the purpose of the visit. On 11/30/2020 LPA Joe Katrdzhyan conducted initial visit.

The investigation consisted of interviews with Staff 1 (S1) and Staff 2 (S2), Client 1 (C1) and Client 3 (C3). On 9/24/2021 from 9:05 a.m. to 9:20 a.m. LPA's interviewed C1 and C3. LPAs were unable to interview C2, for C2 is non verbal. C1 and C3 stated they like living there and staff are kind and treat them well. C1 and C3 stated staff do not yell at them. LPAs interviewed S1 and S2 from 9:20 a.m. to 9:35 a.m. S1 and S2 denied allegation. S1 and S2 stated they like to work at the facility, they enjoy working with people with disabilities and do their best to care for all clients in care.

CONTINUED 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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-20201119103705
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: SIERRA VISTA
FACILITY NUMBER: 198601499
VISIT DATE: 09/24/2021
NARRATIVE
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LPAs were provided with a staff roster and resident roster.

The investigation revealed the following, "Staff verbally abuse residents",on 9/24/2021 LPAs interviewed C1 and C3. (2) out of (2) clients stated staff do not yell at them. C1 and C3 stated they like living there and staff are kind and treat them well. On 9/24/2021 LPAs interviewed S1 and S2. S1 and S2 denied allegation. S1 and S2 stated they like to work at the facility, they enjoy working with people with disabilities and do their best to care for all clients in care.

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

An exit interview was conducted, a copy of the report and appeal rights were provided to Nancy Parker.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2