198602217-10-26-2021-28-AS-WSHO-C9Q2TL-20211214164055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602217
Report Date: 03/26/2020
Date Signed: 10/26/2021 03:48:29 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
03/20/2020 and conducted by Evaluator Pat Rivas

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200320103955

FACILITY NAME:	ELWYN CALIFORNIA - NOVARRO		FACILITY NUMBER:	198602217
ADMINISTRATOR:	CESAR GOMEZ		FACILITY TYPE:	735
ADDRESS:	1027 NOVARRO ST		TELEPHONE:	(626) 500-1430
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	4	CENSUS:	DATE:	03/26/2020
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Cesar Gomez, Administrators		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility staff do not allow resident visitors

INVESTIGATION FINDINGS:

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On 10/26/2021 Licensing Program Analyst (LPA) Nina Galarza has amended the report, which was investigated by LPA P. Rivas, to reflect change in findings and removal of confidential name. LPA Galarza delivered the report and to Lauryn Vaughn on 10/26/2021.

Licensing Program Analyst (LPA) P Rivas initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Cesar Gomez the facility administrator.

LPA Rivas conducted telephone interviews with the administrator, 2 residents, 1 staff. Per Administrator, two other residents are non-verbal. The LPA was provided copyof letter dated March 18, 2020 to families advising of facilities plan to curb Covid-19 virus spread within their facilities. Per telephone interview with Administrator, he reported that they are limiting visitors, advising of the new procedures and following CDC guidelines. LPA was advised families are strongly encouraged to telephone, skype, video visits. Administrator reports that no one has requested visits. Administrator also reported that activities are being done which comply with CDC guidelines. Interview with Staff 1(S1) , at 10:15 to 10:45 am , indicates there have been no visitors, no one has been denied right to visit, all essential appointments are being kept. Interviews with Resident #1(R1) indicates s/he did not have visitors, s/he has not had visitors and visitors can use skype, videos and telephones to call. Resident #2 though verbal did not render answers, Resident stated, "someone in the sky" to LPAs questions.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2020

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-20200320103955

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: ELWYN CALIFORNIA - NOVARRO	FACILITY NUMBER: 198602217
	VISIT DATE: 03/26/2020

NARRATIVE

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Review of letter provided to families indicates in part; Every staff member, visitor, maintenance personnel, therapist, and medical provider who enters the home must pass a health screen upon entry. If a staff/visitor exhibits signs or symptoms of a respiratory illness, we cannot allow them to enter.
 We have limited outings and are adhering to the social distancing requirements as outlined by the CDC (remaining out of congregate settings, avoiding mass gatherings and maintaining distance from others).
 We are restricting visitation of non-essential healthcare personnel and asking families to postpone or cancel visits until the crisis is over. We will seek alternative forms of communication, utilizing technology. Please connect with your respective Home Administrator to discuss available options. "
The following website was the website is one of which facility is using to develop it's guidelines;https://www.cdc.gov/coronavirus/2019-ncov/index.html

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A telephonic exit interview and appeal rights were conducted with George Gomez, and a hard copy was provided via email for signature.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nina Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2020

LIC9099 (FAS) - (06/04)

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