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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602023
Report Date: 06/14/2022
Date Signed: 06/14/2022 04:18:33 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
05/19/2022 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220519141931
FACILITY NAME:CASA FATIMAFACILITY NUMBER:
198602023
ADMINISTRATOR:YUSIMI F. TRAVIESOFACILITY TYPE:
735
ADDRESS:4016 EAST 61ST STREETTELEPHONE:
(562) 682-9667
CITY:HUNTINGTON PARKSTATE: CAZIP CODE:
90255
CAPACITY:4CENSUS: 4DATE:
06/14/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Claudia LujanTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident fell while in care
Staff did not prevent resident from engaging in inappropriate behaviors
Staff handled residents in a rough manner
Staff made inappropriate comments towards resident
Staff threw residents food away
Resident has loss weight
Staff did not safeguard residents personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Administrator Claudia Lujan. The purpose of the visit is to deliver findings.
Initial visit was conducted on 05/25/2022 and the following was done:
Interviews were conducted from 2:10 PM to 2:30 PM with Administrator Claudia Lujan.
Staff S1- S 3 were interviewed from 2:30 PM to 3:10 PM.
Attempts were made to interview Client C 1 who didn't respond to questioning and is non-verbal.
In regards to the allegation Resident fell while in care, based on interviews conducted and information gathered clients interviewed stated that they had never observed anyone smoking marijuana at the facility and then was asleep while C 1 fell. Stated that staff are nice and stated that staff never pushed anyone and had done nothing physical to anyone.
Staff interviewed stated that Client C 1 has behaviors and will swing on the pole in the tub and fall down and bruise himself.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on
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: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
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-20220519141931
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: CASA FATIMA
FACILITY NUMBER: 198602023
VISIT DATE: 06/14/2022
NARRATIVE
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05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
In regards to the allegation Staff did not prevent resident from engaging in inappropriate behaviors, based on interviews conducted and information gathered clients interviewed stated that S1 helps C1 with his meals, meds and showers.
Staff interviewed stated that C 1 was never harmed physically or verbally.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings..
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.
In regards to the allegation Staff handled residents in a rough manner based on interviews conducted and information gathered client's interviewed stated that staff are kind and nice and stated that staff never pushed anyone and had done nothing physical to anyone Stated that Staff S1 has never been mean to Client C1 and has not pushed or been physical with C1.
All staff interviewed had not seen or heard of S1 being abusive to C1.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
In regards to the allegation Staff made inappropriate comments towards resident, based on interviews conducted and information gathered client's interviewed stated that staff are kind and nice and stated that Staff S1 has never been mean to Client C1.
All staff interviewed had not seen or heard of S1 being abusive to C1.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
In regards to the allegation Staff threw residents food away based on interviews conducted and information gathered client's stated that S1 helps C1 with his meals, meds and showers.
Stated that S1 has not thrown away C1's food.
Staff interviewed stated that C1 will be a picky eater and will not let anyone touch his food.





NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20220519141931
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: CASA FATIMA
FACILITY NUMBER: 198602023
VISIT DATE: 06/14/2022
NARRATIVE
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 Stated that he throws his leftovers in the trash and doesn't let anyone touch it.
Another staff has never seen S 1 throw C 1's food away. She saw her cook for him and other clients on the weekend. Said C1 might not want to eat so S 1 puts it into microwave and he gets it later.
Stated she has been there 6 years and never seen C 1 harmed.
Another staff interviewed stated S 1 is good with C1. Takes care of him good. Doesn't throw his food in garbage and has not hit him or pushed him. She works with S1 and she helps C1 with showering.
All staff interviewed had not seen or heard of S1 being abusive to C1.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
In regards to the allegation Resident has loss weight, based on interviews conducted with client's and staff S 1 is not abusive to C1 and helps with all ADL's.
Facility submitted weight logs which show that on 1/12/2022 C1's weight was 126, 2/18/2022 C1's weight was 126, 03/20/2022 C1's weight was 126, 04/23/2022 C1's weight was 127 and 05/16/2022 C1's weight was 127.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
In regards to the allegation Staff did not safeguard residents personal belongings, client's interviewed stated that their personal belongings have always been secured and never missing.
Staff stated that personal belongings of client's have not been missing and that S 1 was redirecting C1 when he was digging through trash.
It should be noted that the investigation by the representative for SCLA Regional Center conducted on 05/25/2022 and 05/26/2022 resulted in Inconclusive findings.
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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3