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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601542
Report Date: 05/15/2025
Date Signed: 05/15/2025 12:45:20 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20240220153155
FACILITY NAME:WILKIE HOMEFACILITY NUMBER:
198601542
ADMINISTRATOR:MARGARITA NUNEZ RENTERIAFACILITY TYPE:
735
ADDRESS:17234 WILKIE AVETELEPHONE:
(310) 538-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:3CENSUS: 3DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Yanett AguilarTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff threw cold water a client while in care
Staff inappropriately grabbed a client's hands while in care
INVESTIGATION FINDINGS:
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On 05/15/25, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent visit to the facility listed above to deliver finding to the above complaint. The department met with Administrator, Yanett Aguilar, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
During a subsequent visit conducted on 02/26/24, the department toured the facility, interviewed Staff (S1 and S3-S9), interviewed Clients (C1-C3), and interviewed Client C2 and C3's Responsible Party W1-W2, and received documents pertinent to the investigation. The documents received and reviewed include the Staff Roster, Client Roster, Training Logs, Special Incident Reports (SIR), Client Body Checks, Client Behavior Plan, Client Behavior Log, Staff Crisis Prevention Intervention, and Staff Abuse Index.

The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 05/15/2025
NARRATIVE
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Allegation: Staff threw water at client while in care
The complaint allegation alleges that staff threw water at a client’s face.
During record review, the department received and reviewed a Special Incident Reports (SIR), that was received by the department on 02/17/2024 regarding an incident that occurred on 02/03/2024. The SIR states S2 asked S5 to get the cup of water in the freezer and saw S2 throw water on C1. The SIR states S5’s focus was on C2 and was in the process of taking C2 to their room. When S2 returned to the living room they observed “a lot of water on the floor.” Additionally, the department received and reviewed an SIR for an incident that occurred on 02/05/2024. S6 in the incident report, stated S2 and S3 began to tell S6 they have found a way to get C1 to calm down during a behavior, they said they spray C1 in the face with water. S6 informed them that is not acceptable and will report it to S1.
During interviews with Staff S1 and S3-S9, were asked if they have knowledge of staff throwing water on C1 during behaviors, four (4) out of eight (8) stated they had knowledge of staff throwing water on C1. Additionally, during interviews with Staff S1 and S3-S9, were asked if they have seen staff throw water on C1, one (1) out of eight (8) stated they have seen staff throw water on C1.
During an interview with Client C3, was asked if staff have thrown water on them or seen staff throw water on other Clients, C3 stated no, they have not seen it, nor had it happened to them.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 05/15/2025
NARRATIVE
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During the course of the investigation, LPA was able to find evidence to support the allegations. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

Allegation: Staff inappropriately grabbed a client’s hands while in care.


The complaint allegation alleges that staff grabbed both client’s hands and held them together.
During file review at the facility, the department received and reviewed staffs CPI Nonviolent Crisis Intervention Training and observed they are current. Additionally, the department received and reviewed staff’s signed Statement Acknowledging Requirements to Report Suspected Abuse of Dependent Adults and Elders. The department received and reviewed staff In-Service Training Logs for the following trainings 10/20/23 Behaviorist Training for behaviors, measurement and data collection, in December 2023 Refocus Strategy, January 2024 for Data Collection and Behavioral Data, and 02/16/24 for Following Behavior Support Plan. During record review, the department received and reviewed a Special Incident Report (SIR) for an incident that occurred on 02/03/24 that indicates S5 observed S2 grab C1’s hands, placing them together, and leading C1 to sit on a recliner. Additionally in the report it was indicated S5 observed S3 and S4 place C1’s hands together, naming it “safe hands” so C1 does not hit the staff. S3 and S4 sit next to C1 with
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 05/15/2025
NARRATIVE
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C1’s “safe hands” being held together while they try to calm C1 down. Additionally, LPA received and reviewed an SIR, that was submitted to the department on 03/08/2024, that on 03/06/2024 Client C3 observed staff garb C1’s arm to get them to the couch.
During interviews with Staff S1and S3-S9, were asked if they or if they have seen staff grab C1’s hands and hold them together during a behavior, one (1) out of eight (8) stated they have seen staff hold C1’s hands together. The staff who observed it stated the staff they saw holding C1’s hands called it “safe hands.”
During an interview with Client C3, was asked if staff have held their hands together or observed staff holding other clients’ hands together during a behavior. C3 stated they have not experienced that, but they have once seen the staff hold C1’s hands together and sit them on the sofa.

During the course of the investigation, LPA was able to find evidence to support the allegations. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

An exit interview was conducted with Administrator, Yanett Aguilar, and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2025
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) to be free from corporal or unusual punishment, inflection of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter,
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Administrator will train staff on Client C1's current behavior intervention plan. Administrator will email LPA (Wendy.Gibbs@dss.ca.gov) log of staff training by 05/16/2025.
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clothing, medication or aids to physical functioning.
This requirement was not met based on interviews and record reviews, C1's personal rights were violated, due to staff S2 and S3 using inappropriate methods to assist C1 with behaviors.
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Type A
05/16/2025
Section Cited
CCR
85161(b)(2)
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85161 Emergency Intervention Documentation and Reporting Requirements (b) Each use of manual restraint or seclusion shall be reported to the Department in writing no later than the next business day. This time frame shall supersede the reporting time frame required by Section 80061(b). (2) If a manual restraint or seclusion technique that was not part of the facility Emergency Intervention Plan or the Individual Emergency Intervention Plan was used during the emergency intervention, the plan for corrective action, at minimum, shall require staff to repeat or obtain emergency intervention training. Within 24 hours of the licensee’s discovery of non-compliance of the Plan, the licensee shall also submit a plan for corrective action to the Department to describe how he or she will ensure that there is no recurrence of a violation of the Plan. This shall not impede upon the
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Administrator will email LPA (Wendy.Gibbs@dss.ca.gov) all staff CPI training, and the CPI that was required for staff to repeat after the incident occured, by 05/16/2025.
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Department’s authority to enforce applicable statues and regulations or initiate administrative action.
This requirement was not met based on interviews and record review, staff used manual restraint on C1 during a behavior by holding thier hands together.
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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.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2024 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20240220153155

FACILITY NAME:WILKIE HOMEFACILITY NUMBER:
198601542
ADMINISTRATOR:MARGARITA NUNEZ RENTERIAFACILITY TYPE:
735
ADDRESS:17234 WILKIE AVETELEPHONE:
(310) 538-8599
CITY:TORRANCESTATE: CAZIP CODE:
90504
CAPACITY:3CENSUS: 3DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Yanett AguilarTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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2
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Client sustained unexplained injury while in care
INVESTIGATION FINDINGS:
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On 05/15/25, the department conducted a subsequent visit to the facility listed above to deliver finding to the above complaint. The department met with Administrator, Yanett Aguilar, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
During a subsequent visit conducted on 02/26/24, the department toured the facility, interviewed Staff (S1 and S3-S9), interviewed Clients (C1-C3), and received documents pertinent to the investigation. The documents received and reviewed include the Staff Roster, Client Roster, Training Logs, Special Incident Reports (SIR), Client Body Checks, Client Behavior Plan, Client Behavior Log, Staff Crisis Prevention Intervention, and Staff Abuse Index.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 05/15/2025
NARRATIVE
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Allegation: Client sustained unexplained injury while in care.
The complaint allegation alleges that a client has a bruise on their right arm.
During record review, the department received and reviewed Skin Monitoring: Daily Skin Check and Body/Skin Check Forms for C1 dated 01/25/2024 through 02/06/24. The department observed C1 has had bruising on the legs from 01/25/2024 through 02/04/2024. Additionally, the department observed C1 had discoloration and redness on the arm on 02/02/2024 and discoloration to the arm and neck on 02/04/2024 and 02/06/2024. The Body Check Forms do not indicate how the bruising or discoloration occurred. Additionally, during record review, the department received and reviewed Client C1’s Individual Person-Centered Plan and Positive Behavior Support Plan that indicates that during a behavior, C1 will engage in self-injurious behavior including scratching and biting self. They additionally stated C1 requires 24-hour care and supervision to ensure safety and well-being. The department received and reviewed the Behavior Data Collection Record for C1 and observed C1 had 13 incidents of Self Injurious Behavior and Physical Aggression on 02/03/24 and 02/04/24. The department additionally received and reviewed a Special Incident Report (SIR) for 02/03/2024, that indicates S2 showed S5 a bruise on C1’s right shoulder. S5 informed S2 that to their understanding C1 did not have any bruising in the morning.
During an interview with Staff S1 and S3-S9, were asked if C1 has had unexplained injuries or bruising, eight (8) out of eight (8) stated C1 has had unexplained injures and bruising and has self-injurious behaviors.
During an interview with Client C3, was asked if they had gotten any bruising or
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 11-AS-20240220153155
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: WILKIE HOME
FACILITY NUMBER: 198601542
VISIT DATE: 05/15/2025
NARRATIVE
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injuries when staff assisted them, C3 stated no.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.



An exit interview was conducted with Administrator, Yanett Aguilar, and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8