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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602557
Report Date: 02/02/2024
Date Signed: 02/02/2024 03:45:37 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
01/29/2024 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240129184828
FACILITY NAME:ALONDRA GUEST HOMEFACILITY NUMBER:
198602557
ADMINISTRATOR:VILLAFLORES, LOURDESFACILITY TYPE:
740
ADDRESS:11849 ALONDRA BLVDTELEPHONE:
(562) 863-7630
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 4DATE:
02/02/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Joy VillafloresTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff are allowing cameras in a resident's room.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint visit at the facility and met with Administrator Joy Villaflores to discuss the purpose for todays visit.


During the visit, LPA Wesley requested a copy of the staff and resident roster,toured the residents rooms, reviewed the medication, and had a conversation with some of the residents.


The investigation revealed the following: In regards to Facility staff are allowing cameras in a resident's room. it was revealed that there is a camera is room #2, The Administrator was informed that they know, they can't have a camera in any of the residents room, only the common areas.

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 4
Control Number 28-AS-20240129184828
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
VISIT DATE: 02/02/2024
NARRATIVE
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Based on LPA observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

California Code of Regulations,Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Appeal rights were given. A copy of the LIC 9099/LIC 9099C/LIC 9099D/LIC 9099A was given during the exit interview.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4
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
01/29/2024 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240129184828

FACILITY NAME:ALONDRA GUEST HOMEFACILITY NUMBER:
198602557
ADMINISTRATOR:VILLAFLORES, LOURDESFACILITY TYPE:
740
ADDRESS:11849 ALONDRA BLVDTELEPHONE:
(562) 863-7630
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 4DATE:
02/02/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Joy VillafloresTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff are over medicating a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint visit at the facility and met with Administrator Joy Villaflores to discuss the purpose for todays visit.

During the visit, LPA Wesley requested a copy of the staff and resident roster,toured the residents rooms, reviewed the medication, and had a conversation with some of the residents.

The investigation revealed the following: In regards to Facility staff are over medicating a resident. Based on the records reviewed, medications observed, interviews with residents revealed that they are given their prescribed medication and they are not over medicated. There was not enough supportive evidence to concur with the reported allegation. 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 copy of the LIC 9099/LIC 9099C/LIC 9099D/LIC 9099A was given during the exit interview.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20240129184828
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: ALONDRA GUEST HOME
FACILITY NUMBER: 198602557
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2024
Section Cited
CCR
87468.1(a)(2)
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Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidenced by
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Administrator removed the camera from the resident #1 bedroom during visit. 02/02/24.

Licensee/Administrator is to send a letter stating that Licensee will comply with section 87468.1
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During the tour of the facilty, LPA observed a camera with audio in resident #2's room, which pose a personal rights violation to persons in care.
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Personal Rights by not violating the residents privacy and send proof of service that your read this section by POC date 02/09/24.
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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.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4