198601509-4-15-2022-28-AS-MVAO-CFDT3V-20220614142258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601509
Report Date: 04/14/2022
Date Signed: 04/15/2022 09:20:20 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
03/28/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220328110826

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:	04/14/2022
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Jessica Ruvalcaba, DSP		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Resident was kicked while in care causing bruising.
Inappropriate form of discipline used against resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegations above. LPA met with DSP staff, Jessica Ruvalcaba, and explained the purpose of the visit. Wendy Torres from the Eastern Los Angeles Regional Center was also present during part of this visit.

The investigation consisted of the following:

On 3/29/2022, LPA Chan conducted the initial investigation and toured the facility for the health and safety check. LPA saw 4 clients lounging in the living room and 3 staff on duty. The food supplies for 2-day perishable and a week of nonperishable were observed. LPA did not observe any immediate health and safety concerns during the visit. LPA obtained the staff roster, client roster, reviewed staff training logs, and documents pertaining to Client #1. Interviews with the Administrator and 4 Staff were completed. LPA interviewed another 2 staff via telephone on 4/11/22. During the visit today, LPA requested training logs for Staff and interviewed Client #1 and #2. The other 2 clients were unable to communicate with LPA.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

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-20220328110826

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: 04/14/2022

NARRATIVE

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The investigation revealed the following:

Regarding allegation – Resident was kicked while in care causing bruising. According to the information provided, the alleged staff repeatedly kicked Client #1 on the left leg, resulting in a large bruise. LPA obtained photos of client #1’s bruise on the left shin, which appeared large and purplish in color. The police were informed of this injury. LPA Chan interviewed the Administrator and 6 staff members. Staff denied kicking Client #1 and did not witness any other staff member doing so. They all stated they are aware of Client #1’s behaviors and will redirect client verbally versus using any form of contact. One staff reported that Client #1 changed the story from bumping into things to being hit by someone. Other staff stated that Client #1 bruises easily and has the tendency to run/bump into things. LPA interviewed Client #1 who indicated that the bruise was caused by hitting the floor. Client denied any staff causing the bruise. According to the Behavioral Consulting Services annual progress report dated 9/8/21, Client #1 exhibits physical aggression such as pushing, grabbing, kicking, and scratching with noted injuries. Based on interviews and record review, there is insufficient evidence to confirm this allegation.

Regarding allegation – Inappropriate form of discipline used against resident in care. Administrator Gatan stated that the staff have the required training and are trained to work effectively with clients. She denied staff using any inappropriate form of discipline on clients. Staff interviewed indicated similar approach in handling clients who display aggressive behaviors. When client charges/attacks staff, they will try to protect themselves by moving aside or placing their hands up with open palms and redirect the client. Staff stated that often time the physical aggressive behaviors are de-escalated by verbally redirecting the client. Staff interviewed had not seen any inappropriate form such as physical or verbal abuse as a way to discipline the clients.

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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator via telephone. A copy of this report signed by the Staff was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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