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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601822
Report Date: 05/11/2023
Date Signed: 05/11/2023 10:47:12 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
08/17/2022 and conducted by Evaluator Kruz Long
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220817142837
FACILITY NAME:SPECIALIZED RESIDENTIAL MONTELLANOFACILITY NUMBER:
198601822
ADMINISTRATOR:CUA-KIM, JANEFACILITY TYPE:
735
ADDRESS:2767 MONTELLANO AVETELEPHONE:
(626) 961-2824
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:4CENSUS: 4DATE:
05/11/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Donovan Covington (Administrator)TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident was sexually abused while in care.
INVESTIGATION FINDINGS:
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*** This complaint report LIC9099 supersedes complaint report LIC9099 dated 09/09/22. ***

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. LPA met with Donovan Covington (Administrator) and explained the purpose of the visit.

During the course of the investigation, LPA attempted to obtain a copy of a police report from local law enforcement but local law enforcement indicated that there was no investigation conducted for this alleged allegation in this facility. LPA also interviewed additional Clients (Client#1, #2 and #3), interviewed additional Staff (Staff #3) and contacted Regional Center but an investigation was not conducted by the Regional Center. During today's visit, LPA interviewed Client #4 via telephone in the front yard.

Continue to LIC9099C....
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
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-20220817142837
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: 05/11/2023
NARRATIVE
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*** This complaint report LIC9099C supersedes complaint report LIC9099C dated 09/09/22. ***

During the initial visit on 08/18/22, LPA conducted a health and safety check and obtained a copy of the Staff/Client roster. LPA toured the facility and observed the facility to be clean and in good repair. LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Restrooms, handwashing basins, toilets and bathtub/showers are operable. There are no immediate health and safety concerns during today's visit.

During a subsequent visit on 09/09/22, LPA obtained a copy of Client #1's records (Physician's Report, Individual Program Plan, Behavior Assessment) and interviewed Staff #1 and Staff #2 in the garage.

In regards to the allegation: Resident was sexually abused while in care. Interviews with 3 of 3 Staff indicate they have never sexually abused a Client nor have they witnessed other Staff sexually abuse a Client. Interviews with 2 of 4 Clients indicate they have never been sexually abused by Staff nor have they witnessed Staff sexually abusing other Clients and was unable to corroborate the allegation. Local law enforcement and Regional Center did not investigate the above allegation.

Based on LPA's 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 Donovan Covington 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: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2