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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601668
Report Date: 06/22/2022
Date Signed: 06/22/2022 11:29:50 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
02/10/2021 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210210150122
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:
06/22/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Samira Menendez (Licensee)TIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility staff financially abused resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kruz Long conducted a site visit to the facility to investigate the above allegation. Upon arrival, LPA met with Samira Menendez (Licensee) and explained the purpose of the visit.

During the initial investigation conducted on 02/19/21, LPA requested a copy of the Staff/Client roster, Client #1's records and interviewed Staff #1, #2.

During today's visit, LPA obtained a copy of the Staff/Client rosters, Client #1's Medical appointment record, Individual program plan and IPP planning meeting/Review agreement.

In regards to the allegation: Facility staff financially abused resident. Based on interviews and record review, Client #1 is responsible for their own finances and facility has no involvement in managing Client #1's finances. Client #1 was not able to provide financial records pertaining to a stimulus card that indicate staff committed any type of financial abuse. Continue to LIC9099....
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2022
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-20210210150122
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: 06/22/2022
NARRATIVE
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Based on interviews and record review, 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 Samira Menendez and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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