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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601668
Report Date: 05/24/2022
Date Signed: 05/24/2022 02:39:18 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
12/15/2021 and conducted by Evaluator Tony Vasallo
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20211215160355
FACILITY NAME:CASA MENENDEZFACILITY NUMBER:
198601668
ADMINISTRATOR:RAFAEL MENENDEZFACILITY TYPE:
735
ADDRESS:8521 STEWART & GRAY RD.TELEPHONE:
(562) 381-0000
CITY:DOWNEYSTATE: CAZIP CODE:
90241
CAPACITY:4CENSUS: 4DATE:
05/24/2022
UNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Administrator, Samira MenendezTIME COMPLETED:
02:55 PM
ALLEGATION(S):
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Client hit another client in care.
Client is verbally abusive to another client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit to investigate the allegations listed above. The initial complaint visit was conducted by LPA Nina Galarza on 12/23/21. LPA met with Administrator, Samira Menendez and explained the reason for the visit.

The investigation consisted of the following: LPA Galarza interviewed 2 staff and obtained copies of staff and client roster. LPA Vasallo interviewed 5 staff, 2 clients and a regional center representative. LPA Vasallo also reviewed Client #1's (C1's) Individual Program Plan (IPP) and additional reports from regional center.

The investigation revealed the following: It's alleged C1 hit Client #2 (C2) in the facility. Staff interviewed indicated they have never witnessed a client hit another client. C1 and C2 were interviewed. Both clients deny anyone being hit. C1's day program coach was interviewed and he/she indicated they have never seen any injuries on C1. Regional center representative indicated there was no proof C1 was hit. Based on the information obtained, the allegation is unsubstantiated.
Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
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-20211215160355
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: CASA MENENDEZ
FACILITY NUMBER: 198601668
VISIT DATE: 05/24/2022
NARRATIVE
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Client is verbally abusive to another client in care. Allegedly C2 called C1 a cuss word in Spanish. Both clients were interviewed and both denied the allegation. Staff interviewed reported never hearing C2 call C1 names. Based on the information obtained, the allegation is unsubstantiated.

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 allegation is unsubstantiated.

Exit interview held. A copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2