198601509-6-29-2022-28-AS-LHIS-CGVUHC-20220801153540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601509
Report Date: 06/29/2022
Date Signed: 06/29/2022 05:13:40 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
04/22/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220422123536

FACILITY NAME:	ELWYN NC - DE SALES		FACILITY NUMBER:	198601509
ADMINISTRATOR:	EDWARD VELARDE		FACILITY TYPE:	735
ADDRESS:	610 N DE SALES ST		TELEPHONE:	(626) 872-6983
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91775
CAPACITY:	4	CENSUS: 4	DATE:	06/29/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Hazel Gatan, Administrator		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Residents are throwing trash into neighbors wall.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint to deliver findings on the above allegations. The purpose of the visit was discussed with Administrator Hazel Ortega.

The investigation consisted of: On 4/27/22 & today an inspection of the interior and exterior physical plant was conducted. Staff (S1-S4), (2) neighbor interviews, and Eastern Los Angeles Regional Center Service Coordinator were interviewed. Clients are non-verbal and were not interviewed. Auditory alarms on exit doors were observed. LPA obtained the following documents: Eastern Los Angeles Regional Corrective Action Plan dated [4/20/2022], LIC 500 Personnel Report, resident roster, and client (C1's) file documents [IPP, Face Sheet, Physician Report.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

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-20220422123536

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: ELWYN NC - DE SALES	FACILITY NUMBER: 198601509
	VISIT DATE: 06/29/2022

NARRATIVE

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Allegation: "Residents are throwing trash into neighbors wall." It is alleged that clients throw trash over to the neighbor's property and staff do not stop or redirect clients behaviors. It is also alleged that staff throw leaves into the neighbor's Camelia bushes. It was reported that a dirty rag was thrown over as well. Staff stated that client (C2) has a behavior in which it tries to climb over to get oranges from a tree, but it does not throw the oranges over to the neighbor's property. Staff denied this allegation. During the visits, no debris was observed in the exterior facility grounds or on the neighbor's property. There is no supportive evidence to corroborate this allegation.

Therefore, 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 was held with Administrator Hazel Gatan. A copy of the report was issued.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022

LIC9099 (FAS) - (06/04)

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