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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601940
Report Date: 11/15/2022
Date Signed: 11/16/2022 09:01:04 AM

Substantiated


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
11/10/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221110153403
FACILITY NAME:VILLA FLORAFACILITY NUMBER:
198601940
ADMINISTRATOR:ROSALINDA BUENVIAJEFACILITY TYPE:
735
ADDRESS:10932 CARMENITA RD.TELEPHONE:
(562) 941-5249
CITY:WHITTIERSTATE: CAZIP CODE:
90605
CAPACITY:34CENSUS: 32DATE:
11/15/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joel AlonzoTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff yelled at resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator Joel Alonzo and explained the purpose of today’s visit.

Regarding the allegation that Staff #1 yelled at resident #1. The investigation consisted of interviews with Administrator, Staff #1 - Staff #3, and Resident #1 - Resident #3. The investigation revealed that Staff #1 and Resident #1 had a verbal argument on 11/9/22. Administrator stated that he was not aware of this incident. He stated that there was an incident in the past that he observed staff #1 yell at resident #1, and he spoke to staff #1 about it. Staff interviewed did not corroborate the allegation. Staff #1 did not admit that she yelled at resident #1. Residents interviewed corroborated the allegation. Resident #1 - Resident #3, stated that Staff #1 does yell at resident(s).
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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-20221110153403
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: VILLA FLORA
FACILITY NUMBER: 198601940
VISIT DATE: 11/15/2022
NARRATIVE
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Based on LPA's observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20221110153403
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: VILLA FLORA
FACILITY NUMBER: 198601940
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2022
Section Cited
CCR
80072(a)(1)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement is not being met as evidenced by:
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Administrator will provide in service training to all facility staff. Administrator will ensure that staff treat residents with dignity and respect per title 22 regulations. Administrator will send proof of training to LPA by POC due date.
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LPA learned during the course of investigation that Staff #1 yelled at resident #1 on 11/9/22.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3