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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601509
Report Date: 01/20/2023
Date Signed: 01/20/2023 03:12:40 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
01/17/2023 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230117090335
FACILITY NAME:ELWYN NC - DE SALESFACILITY NUMBER:
198601509
ADMINISTRATOR:HAZEL A. GATANFACILITY TYPE:
735
ADDRESS:610 N DE SALES STTELEPHONE:
(626) 872-6983
CITY:SAN GABRIELSTATE: CAZIP CODE:
91775
CAPACITY:4CENSUS: 4DATE:
01/20/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Martin Sy, AdministratorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff did not ensure solid waste is properly disposed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit in reference to the above allegation. LPA met with new Administrator Martin Sy.

The investigation consisted of the following: A tour of the interior and exterior physical plant was conducted; with a focus of the backyard trash bin area. Staff (S1- S3) were interviewed. Clients in care are developmentally disabled and non-verbal; therefore were not interviewed. A copy of the LIC 500 Personnel Report and client roster was obtained.

See LIC 9099C for report continuation.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
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 3
Control Number 28-AS-20230117090335
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: 01/20/2023
NARRATIVE
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Allegation: Staff did not ensure solid waste is properly disposed. It is alleged that facility staff are overfilling the trash bins, putting extra trash on the ground, and not emptying the garbage bins in a timely manner, and as a result rodents such as, rats, cats, and coyotes are being attracted to the food source in the trash bins. In addition, it is alleged that staff slam the side door and garage door and make a lot of noise when moving the trash bins from the backyard to the front curve side for trash pick-up. Three (3) staff were interviewed. Staff stated that the trash bins are never overflowing because the facility has five (5) city trash bins, and typically only three (3) or four (4) trash bins are used per week. Per Administrator, staff in each shift are responsible for throwing out the bathroom, kitchen, and bedroom trash before the end of their shift. The facility has two (2) round recycling trash bins along the property block wall.

Based on observation, the findings indicate that on today’s date discarded furniture i.e. sofa recliner, patio furniture, vacuum, tables, patio umbrella, and chairs were observed near and in the trash bin area posing a healthy and safety hazard. Per Administrator, all the discarded furniture and trash was taken out to the trash area last week because new furniture was purchased, and the waste management department was called to schedule bulky item pick up, but the soonest they could pick up the items was until Tue. Jan. 24, 2023.

Based on observation the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22.



An exit interview was conducted with Martin Sy. A copy of the report an appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230117090335
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/27/2023
Section Cited
CCR
80087(a)
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Buildings and Grounds. (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement was not met evidenced by:
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Administrator stated that bulky item pick-up was scheduled with city waste management department. The items will be picked up Tue. Jan 24, 2023. Administrator removed the discarded furniture and placed the items in the garage as a temporary measure.
Submit picture proof evidence that the items were discarded.
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Based on observation, discarded furniture i.e. sofa recliner, patio furniture, vacuum, tables, patio umbrella, and chairs were observed near and in the trash bin area; which poses a potential health and safety hazard to persons in care.
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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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3