198602094-10-8-2024-28-AS-TVAO-DA5LR9-20241017085842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602094
Report Date: 10/08/2024
Date Signed: 10/08/2024 11:54:47 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
10/02/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241002115722

FACILITY NAME:	VILLA ESPERANZA SERVICES (DIMENSIONS)		FACILITY NUMBER:	198602094
ADMINISTRATOR:	CLAUDIA CORTEZ		FACILITY TYPE:	775
ADDRESS:	1990 EAST WALNUT STREET		TELEPHONE:	(626) 449-2919
CITY:	PASADENA	STATE: CA	ZIP CODE:	91107
CAPACITY:	65	CENSUS: 46	DATE:	10/08/2024
		UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Melany Gon - Lead Staff		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff did not prevent a client from hitting another client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation. LPA met with Melany Gon and explained the reason for the visit.

The investigation consisted of the following: LPA requested copies of staff/client roster. LPA interviewed 5 clients and 5 staff, reviewed client #1-#2(C1-C2)’s file and requested copies of individual program plan (IPP), individual service plan, physician’s report, face sheet, incident report.

The investigation revealed the following: Regarding allegation: Staff did not prevent a client from hitting another client. It is alleged C1 struck C2 on the shoulder with an open hand and staff while at program. Interviews with clients revealed that other clients do not try to hit them, and they get along well. Interview with C2 revealed C1 did tap her on her shoulder, it hurt, but they get along. Interviews with staff revealed staff are knowledgeable of clients’ behaviors, staff observe the clients’ mood and desires for the day to prevent outburst or behaviors, as well as if an incident happens, they provide space to the client and assist during the behavior. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

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-20241002115722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VILLA ESPERANZA SERVICES (DIMENSIONS)	FACILITY NUMBER: 198602094
	VISIT DATE: 10/08/2024

NARRATIVE

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Regarding the incident the staff that witness the incident stated C1 did hit C2 with an open hand but not in a motion that will cause harm rather like a tap. C1 was dealing with emotions at that moment and C2 was next to C1, resulting in C2 hitting C1 in the back closed to the shoulder. Staff checked C2 for marks or redness and nothing was observed. C1 was separate to allow space to calm down. Documents review revealed, incident report dated 10/1/24 submitted to the department notes C1 was showing some self-harmful behaviors, staff prompted C1 to calm down, and C1 proceeded to hit C2 on the right shoulder with an open hand. C2 stated to be “hit”, staff asked permission to check for marks or injuries. No marks or injuries were noticed. Individual Service Plan dated 9/5/23 notes a plan to assist C1 with emotion triggers and healthy ways to respond, social skills, and information on types of behaviors to assist with interpersonal relationships. C1’s IPP dated 8/21/23 notes, in the past C1 had several incidents in which would hit, scratch others. However, they have not been reports of them occurring recently. Physician’s report dated: 5/8/19 notes C1 needs redirection to follow instructions.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Claudia Cortez and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Mary G Flores
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2024

LIC9099 (FAS) - (06/04)

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