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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601822
Report Date: 01/28/2025
Date Signed: 01/28/2025 03:20:28 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
01/23/2025 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250123111832
FACILITY NAME:SPECIALIZED RESIDENTIAL MONTELLANOFACILITY NUMBER:
198601822
ADMINISTRATOR:DONOVAN COVINGTONFACILITY TYPE:
735
ADDRESS:2767 MONTELLANO AVETELEPHONE:
(626) 961-2824
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:4CENSUS: 4DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Adminsitrator Janet De LunaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff left resident unattended in the facility
Staff do not maintain a comfortable temperature in the facility
Staff did not ensure that residents were adequately fed
Staff mismanaged resident medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with Adminsitrator Janet De Luna and the purpose of the visit was discussed.

On todays visit LPA conducted the following: LPA interviewed staff #1-#4 (S1-S4) and clients #1-#4 (C1-C4). LPA toured the physical plant and observed the food supply. LPA collected and reviewed copies of the staff roster, client roster, C1-C4s facesheet, food menu, reports for the clients placement agency, and documents from C1's file related to the allegations. LPA also reviewed client medications. The investigation revealed the following:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 3
Control Number 28-AS-20250123111832
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: SPECIALIZED RESIDENTIAL MONTELLANO
FACILITY NUMBER: 198601822
VISIT DATE: 01/28/2025
NARRATIVE
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In regards the allegation "Staff left resident unattended in the facility" it was alleged that staff left C1 alone in the facility on 1/14/25. (4) of (4) Staff denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Staff interviewed denied that C1 was left alone on 1/14/25. S2 stated to be working that very morning when C1 verbally signed out to go out into the community and refused to sign the sign out sheet. C1 confirmed they notified staff of signing out on 1/14/25 but did not sign the sheet. LPA verified through a text between C1 and S1 showing they signed out at 8:59am on 1/14/25. C1 stated staff were present prior to C1 leaving the facility and that C1 has never been left alone. Based on LPA's interviews, file review, and observations ; although the allegations 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.

In regards to the allegation "Staff do not maintain a comfortable temperature in the facility" it was alleged that the facility thermostat is not being regulated and it makes the facility an uncomfortable living environment. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Title 22 states that the facility temperature should be between 68-85 degrees to be considered comfortable. LPA observed the facility thermostat to be at 71 degrees during the visit. Clients interviewed stated the facility is not uncomfortable but it does get warm at times. The thermostat is then lowered. Staff interviewed denied there being issues with the temperature of the facility. There are no documents showing there to be issues with the facilities thermostat. Based on LPA's interviews, file review, and observations ; although the allegations 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.

In regards to the allegation "Staff did not ensure that residents were adequately fed" it is alleged that clients are only provided cereal and coffee as meals. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Staff interviewed stated that clients choose to have cereal most mornings but there are plenty of different meals they have throughout the day. Clients are not denied options of meals. Clients interviewed stated they like certain cereals and have no issue with cereal in the mornings. Clients stated they have different meals throughout the day and enjoy the food menu. LPA observed an adequate supply of stored food in the facility. Based on LPA's interviews, file review, and observations ; although the allegations 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.

Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250123111832
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: SPECIALIZED RESIDENTIAL MONTELLANO
FACILITY NUMBER: 198601822
VISIT DATE: 01/28/2025
NARRATIVE
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In regards to the allegation "Staff mismanaged resident medication" it is alleged that C1 is not provided their medication as prescribed. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Staff interviewed stated that C1 does not have medication prescribed on a cycle that need to be taken daily. C1 only has medication to be taken as needed. C1 denied having medication issues at the facility and does not request medication from staff. LPA observed the medication supply for clients in care and did not observe any errors or missed medications. Based on LPA's interviews, file review, and observations; although the allegations 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 and a copy of this report provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3