198601791-6-27-2023-28-AS-RORN-CV7T4V-20230830142434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601791
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:32:21 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
06/09/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230609142734

FACILITY NAME:	CRYSTAL MANOR RESIDENTIAL CARE HOME		FACILITY NUMBER:	198601791
ADMINISTRATOR:	CHRISTINA HADDADIN		FACILITY TYPE:	735
ADDRESS:	3406 BALDWIN PARK BOULEVARD		TELEPHONE:	(626) 337-1424
CITY:	BALDWIN PARK	STATE: CA	ZIP CODE:	91706
CAPACITY:	26	CENSUS: 23	DATE:	06/27/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Christina Haddadin		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff imposed restrictions on resident’s right to have visitors.
Staff threatened a resident.

INVESTIGATION FINDINGS:

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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 06/13/2023 the following occurred:
LPA interviewed Administrator at 1:40 PM.
Client and staff roster was submitted. House Rules, Visitor policy, Special Incident reports (SIR'S) and Eviction Notice were submitted.
Client 1's file was reviewed and Admission Agreement and Physician's Report were submitted.
At today's visit 06/27/2023 Client's C1- C 6 were interviewed from 11:00 AM to 12:00 PM. Client Roster was submitted.
In regards to the allegation Staff imposed restrictions on resident’s right to have visitors, based on interviews conducted and information gathered interview with Client C 1 who stated that 2 weeks ago his sister had visited him at the facility. Also stated that visitors are allowed and just have to sign in with the Administrator.

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: 06/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230609142734

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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All client's interviewed stated they have had visitors and you have to just let the administrator know.
Client's from 1 year to 28 years residing here stated that they have had their own family members visit and also have seen other client's family members visit.
Staff interview stated that visitors are allowed and as stated in Admission Agreement an appointment must be made first.
Admission Agreement dated 01/01/2023 and signed by C 1 specifies that the visiting policy is from 8:00 AM to 6:00 PM and must call and make an appointment before any visitations.
House Rules and Visitation Policy updated 05/13/23 and signed by all client's but 1 who has a Conservator which specifies 48 hours notice for visitation.
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 Staff threatened a resident, based on interviews conducted and information gathered 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.
Interview with staff who stated that C1 did not pay his rent by the 10th day of the due date.
Administrator stated that a certified letter was sent to family member of C 1 to submit check to facility.
LPA observed copy of certified mail sent and also USPS postal package with check received by the facility dated 06/14/23.
Notice to pay rent or quit was sent to family member of C1 on 06/07/23 stating that $1332.82 was due 06/01/23 and to be paid no more than 5 days later and now has to be paid within 3 days of the date of the letter.
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: 06/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023

LIC9099 (FAS) - (06/04)

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