198602384-8-11-2020-11-AS-MVAO-BSFNZP-20200813105440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602384
Report Date: 08/07/2020
Date Signed: 08/11/2020 11:24:20 AM

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 DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2020 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200714103850

FACILITY NAME:	FOUNTAINVIEW AT GONDA WESTSIDE		FACILITY NUMBER:	198602384
ADMINISTRATOR:	STEWART, BRADLEY THOMAS		FACILITY TYPE:	741
ADDRESS:	12490 WEST FIELDING CIRCLE		TELEPHONE:	(424) 216-7788
CITY:	PLAYA VISTA	STATE: CA	ZIP CODE:	90094
CAPACITY:	286	CENSUS: 241	DATE:	08/07/2020
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Charlette Offrecio, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not adequately supervise residents resulting in an altercation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint visit to provide findings and decision for the allegations 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 Charlette Offrecio, the facility administrator.

Based on LPA Soto investigation, the investigation revealed the following: For Allegation: Staff did not adequately supervise residents resulting in an altercation. LPA Soto reviewed 2 residents files in which neither resident needed direct supervision. The are both independent and can decide what relationships/friendships they want to develop for themselves. On 08/04/20, at around 11:00am, LPA Soto interviewed R#4 & R#5, they stated that they had been involved in a relationship/friendship and have had some issues with that relationship/friendship, allegedly might have become physical, R#4, says “YES” and R#5 says, “NO”.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020

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 11-AS-20200714103850

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 DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: FOUNTAINVIEW AT GONDA WESTSIDE	FACILITY NUMBER: 198602384
	VISIT DATE: 08/07/2020

NARRATIVE

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The facility was aware of the relationship/friendship and when this altercation occurred there were no witnesses to the altercation, therefore, the administrator advised both residents to end the relationship/friendship, to avoid any further altercations. On 08/04/20 @ around 9:30am LPA Soto interviewed Staff #1; the administrator stated that the residents had been in a relationship/friendship for some months, they were doing fine as far as she knew. When this altercation happened, no one had seen anything besides the residents, so, I’ll she could do is advise them to stay away from each other to avoid further altercations. On 07/02/20, the day of the altercation, 911 was called by R#4, the police arrived and investigated, but did not arrest anyone, they were only wrote an incident report. On 08/04/20 at around 02:30pm, LPA Soto interviewed S#2 -#5 and R#1 - #3, they all stated that they have never witnessed any physical altercation between R#4 & R#5. The R#4 & R#5 have ended their relationship/friendship and there have been no other altercations.

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

A telephonic exit interview was conducted with Charlette Offrecio, Administrator, and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2020

LIC9099 (FAS) - (06/04)

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