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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602217
Report Date: 09/07/2022
Date Signed: 09/07/2022 12:50:29 PM

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
08/29/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220829095843
FACILITY NAME:ELWYN CALIFORNIA - NOVARROFACILITY NUMBER:
198602217
ADMINISTRATOR:CESAR GOMEZFACILITY TYPE:
735
ADDRESS:1027 NOVARRO STTELEPHONE:
(626) 699-1889
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
09/07/2022
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Estela Barrera TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility is in disrepair.
Facility does not provide a comfortable environment for residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint visit to the facility to investigate the above allegations. LPA met with House Manager Estela Barrera and explained the purpose of the visit and she also assisted LPA with the visit.

The investigation consisted of the following: On today's date, LPA interviewed four clients (C1-C4), three staff (S1-S3) and administrator on the phone. LPA also toured the facility and obtained the copy of the invoice from Air Conditioning Company dated on 09/01/2022.


(See LIC 9099C for continuation)

Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
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-20220829095843
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: 09/07/2022
NARRATIVE
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The investigation revealed of the following: Regarding allegation "Facility is in disrepair." LPA interviewed all clients and they all reported the air conditioning (A/C) was broken about for three weeks. The facility was really hot. LPA interviewed administrator and staff and all admitted that the A/C was broken for three weeks but the A/C company did come and fix the A/C and replaced the existing A/C system last week. There were some parts that A/C company still needs to be repaired and they should be completely finished by next week.

Regarding allegation: "Facility does not provide a comfortable environment for residents." LPA interviewed all clients and reported it was hot in the facility last few weeks and it's very difficult to feel comfortable in the facility. The facility did provide portable A/C in the rooms but they still felt hot. LPA interviewed staff and reported the facility was very hot and the clients was impatient and uncomfortable and some clients were sweating a lot. The staff indicated that they did hook up seven fans and portable A/C in each clients' room, living room and kitchen to make the clients feel more comfortable in the facility while the A/C was broken.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview held with House Manger Estela Barrara. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220829095843
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2022
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

The requirement was not met as evidenced by
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The facility will ensure the facility shall be clean, safe and sanitary and in good repair at all times. The company will fix the A/C as soon as possible and send the invoice to LPA by POC due date.
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LPA's interviews and record reviewed, LPA interviewed clients and staff and all reported the air conditioning (A/C) in the facility was broken in the past few weeks. LPA also reviewed the invoice from A/C company and it indicated that the existing HVAC systems was replaced which posed a potential risk for clients in care
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(POC was cleared during the complaint visit)
Type B
09/14/2022
Section Cited
CCR
80072(a)(2)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
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The facility will ensure the clients shall have personal right include to be accorded healthful and comfortable accommodations to meet his/her needs. The facility will retrain the staff on personal right, will send the staff training log to LPA by POC due date
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The requirement is not met as evidenced by:
LPA's interviews and clients reported its difficult to feel comfortable and its very hot in the facility which posed a potential risk for clients in care.
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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: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/07/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3