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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601551
Report Date: 11/22/2022
Date Signed: 11/22/2022 10:07:12 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
11/15/2022 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20221115152635
FACILITY NAME:SANDRA'S HOUSE LLC #2FACILITY NUMBER:
198601551
ADMINISTRATOR:SANDRA BENSONFACILITY TYPE:
735
ADDRESS:9902 PARK STTELEPHONE:
(562) 843-8522
CITY:BELLFLOWERSTATE: CAZIP CODE:
90706
CAPACITY:4CENSUS: 4DATE:
11/22/2022
UNANNOUNCEDTIME BEGAN:
08:38 AM
MET WITH:Administrator Sandra BensonTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Uncleared adults caring for residents
INVESTIGATION FINDINGS:
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On 11/22/22 at 08:38 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation to the facility. Upon arrival LPA met with staff#1 (S1) and explained the reason for the visit. Administrator Sandra Benson Joined the visit at 8:50 and LPA explained the purpose of the visit.

During today’s visit LPA toured the facility with S2, obtained resident/ staff roster, and staff schedule. LPA interviewed administrator, S1 and S2. Clients# C1 through C4 is nonverbal. Due to communication limitations, LPA was not able to interview the clients.


Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
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-20221115152635
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: SANDRA'S HOUSE LLC #2
FACILITY NUMBER: 198601551
VISIT DATE: 11/22/2022
NARRATIVE
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The investigation reveals the following: Regarding “Uncleared adults caring for residents “, it is alleged that the facility hires staff with false social security numbers. Upon arrival LPA met S1 and S2 arrived during the visit. During the tour LPA did not observe additional staff members working at the facility. Both S1 and S2 were associated to the facility. Administrator Benson provided LPA with a staff roster and weekly schedule. LPA cross referenced both documents with association list printed 11/15/22 and all names listed were cleared. Administrator Benson stated all staff is associated and fingerprinted prior to them starting work at the facility. During the interview S1 named all staff they have worked with and all are associated to the facility. S2 stated there was only one incident but it was an expired driver’s license, to S2’s knowledge all staff is associated to the facility.

Based on LPA's interviews, file review and observation the investigation revealed: 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 conducted with S2 and a copy of this record provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2