198601791-7-15-2025-28-AS-WSHO-DL8PMU-20250905112652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601791
Report Date: 07/15/2025
Date Signed: 07/15/2025 05:00:13 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
07/06/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250706221514

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: 19	DATE:	07/15/2025
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Christina Haddadin		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff do not provide adequate care and supervision of a client
Staff do not properly report incidents involving a client

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegations. LPA meet with Administrator who assisted with the visit. The purpose of the visit was explained.

The investigation consisted of the following: Obtained copies of Staff & Clients Rosters, interviewed Administrator, Staff 1(S1) - Staff 2 (S2), Client 2 (C2) - Client 4 (C4), Case Manager (CM) from Placement Agency and Family Member(FM). LPA also reviewed C1's file and obtained the copies of relevant documents. LPA was not able to interview C1 because C1 was at the hospital.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

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-20250706221514

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: 07/15/2025

NARRATIVE

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Staff do not provide adequate care and supervision of a client. It was alleged that C1 went into a large garbage bin, fell asleep inside the bin and then got taken to drop off waste area.

Interviewed Administrator and staff denied that staff do not provided adequate care and supervision to clients. They stated there are always enough staff at the facility for care and supervision. Interviewed Administrator and S1 stated that C1 was not seen at the facility around 8:00 pm on 07/02/25. They stated that was not alarming at the time because in the past C1 has walked to their FM house and returned back. FM was always contacted and they return C1 to the facility. FM was contacted and notified that C1 was not at the facility. Administrator also contacted to C1's Case Manager from the Placement Agency and therapist. Administrator stated on 07/03/2025, before a missing person report could be made, Azusa Police Department had made contact with her and notified that C1 had got into a dump truck and ended up at the drop off waste area. C1 had no injuries and stated that they had just fallen asleep in the dumpster. For precautionary reason C1 was transported to the Hospital. Administrator indicated when C1 first arrived, they would soil themself, in a protest manner. C1 had hopes that the facility would evict them, and C1 would be able to go home. Administrator said C1 may have used this incident (went into a garbage bin)as another form of protest, because C1 wants to return home, even though that is not an option for C1 anymore. Administrator stated upon discharge planning Crystal Manor will follow medical advice to see if C1 is still eligible to be at facility level, or if C1 is in need higher level of care and supervision. Interviewed CM stated after they notified about the incident, they went to the hospital for evaluation. It was determined that C1 met criteria for 5150 hold for danger to self. Interviewed FM stated that they knew that C1 is at the hospital. FM indicated that Facility administrator and CM called them and notified about the incident. On LPA's question if they have any additional information they stated that they not a responsible party for C1 and C1 is adult and can take care of themselves. Interviewed clients stated that they didn't hear about the incident. Client interviews do not corroborate the allegation.

Continue 9099C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20250706221514

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: 07/15/2025

NARRATIVE

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Staff do not properly report incidents involving a client. It was alleged that Staff not report client is missing.
Interviewed Administrator and staff denied the allegation. They stated that staff always properly report any incident involving client. Interviewed Administrator indicated that before C1 could be consider as a missing person They stated that was not alarming at the time because in the past C1 has walked to their FM house and returned back. C1's FM was contacted by Administrator and notified that C1 not at the facility from 07/02/25 at 8:00pm. Administrator also contacted to C1's Case Manager from the Placement Agency and therapist. On 07/03/2025, before a missing person report could be made, Azusa Police Department had made contact with Administrator and notified that C1 had got into a dump truck and ended up at the drop off waste area. Administrator was notified C1 had no injuries and stated that C1 had just fallen asleep in the dumpster. Case report number was provided by Police Officer. Administrator confirmed that SIR was sent to Licensing Department on 07/04/25. Copy of SIR was provided.

Based on record review, interviews conducted 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 allegations are Unsubstantiated.

An exit interview conducted, and a copy of this report was provided to Administrator

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025

LIC9099 (FAS) - (06/04)

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