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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601791
Report Date: 06/27/2023
Date Signed: 11/04/2023 02:11:22 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
05/11/2023 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230511155614
FACILITY NAME:CRYSTAL MANOR RESIDENTIAL CARE HOMEFACILITY NUMBER:
198601791
ADMINISTRATOR:CHRISTINA HADDADINFACILITY TYPE:
735
ADDRESS:3406 BALDWIN PARK BOULEVARDTELEPHONE:
(626) 337-1424
CITY:BALDWIN PARKSTATE: CAZIP CODE:
91706
CAPACITY:26CENSUS: 23DATE:
06/27/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sherman ThaiTIME COMPLETED:
10:50 AM
ALLEGATION(S):
1
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9
Illegal eviction
Licensee is not providing refund to authorized representative
INVESTIGATION FINDINGS:
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This is an amended report for the purpose of removing confidential information and adding additional information.This amended report does not change the findings.LPA Ramirez redelivered report on 11/04/2023 and obtained signatures on the hard copy.
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Christina Hadddadin and explained the reason for the visit.
The purpose of the visit is a subsequent complaint visit to investigate the above allegations.
At initial visit on 05/16/2023 the following occurred:
Client and staff roster was submitted. Administrator was interviewed at 9:45 AM. Staff S 1 was interviewed at 10:15 AM. Client 1's file was reviewed and Admission Agreement and Physician's Report was submitted. At today's visit 06/27/2023 Client's C1- C 6 were interviewed from 9:15 AM to 10:20 AM. Client Roster was submitted.
In regards to illegal eviction based on interviews conducted and information gathered Client C 1 stated that there was an incident between himself and the Administrator and afterwards went to the hospital, but there were no hospital beds. Stated that the Administrator took him back and he was not evicted.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2023
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 2
Control Number 28-AS-20230511155614
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: CRYSTAL MANOR RESIDENTIAL CARE HOME
FACILITY NUMBER: 198601791
VISIT DATE: 06/27/2023
NARRATIVE
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Staff interviewed stated that C1 is still here and was never evicted. Staff stated that there was no eviction notice given. LPA on visits conducted on 05/16/2023 and 06/27/2023 reviewed the roster which included Client C 1 who was also interviewed and is still a resident.
Interviews with C 2- C 6 who stated that staff are professional and just stick by the rules and had not heard anyone threatened with eviction. Also stated that staff have never been verbally or physically abusive.
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.

In regards to the allegation Licensee is not providing refund to authorized representative, based on interviews conducted and information gathered staff interviewed stated that C 1 had wanted to leave and family member of C 1 had wanted to put him in a hotel and administrator stated that she had told family member that they would both have to sign off on the refund check.
Administrator Special Incident Report (SIR) dated 05/11/2023 stated that Administrator agreed to give C 1 a refund for the rest of the month of May.
Attached to the SIR was the text exchange with Administrator and family member of C 1 which LPA observed and it stated by Administrator that she was going to leave at 5 and if she didn't make it by then she can still get the check this weekend.
It should be noted that a refund was not issued since client in question was never discharged/evicted from the facility. Family member of Client C 1 was interviewed on 05/31/2023.
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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2