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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 02/15/2022
Date Signed: 02/15/2022 04:30:05 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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2022 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20220211085342
FACILITY NAME:LONG BEACH RESIDENTIALFACILITY NUMBER:
198602620
ADMINISTRATOR:BONZON, TEDFACILITY TYPE:
735
ADDRESS:4201 EAST 10TH STREETTELEPHONE:
(562) 433-2455
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:49CENSUS: 45DATE:
02/15/2022
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Crystal Barrentios TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Residents use illegal drugs inside of the facility.
Staff are not addressing residents' aggressive behavior.
INVESTIGATION FINDINGS:
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On 02/15/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced compliant investigation, regarding the allegation(s) above. LPA was Met by facility Assistant Administrator, and the purpose of the visit was explained.

Investigation Consisted of: Administrator Interview, Client Interviews, Record Review, and Physical Plant tour. The following documentation was requested: Staff Roster, Client Roster, Written Warnings, Physicians Report, and Needs and Services Appraisal.

Regarding Allegation: Residents use illegal drugs inside of the facility.
3 Clients in care (C1, C2, C3) were named in the allegation above, to be using illegal drugs inside of the facility. Interviews with the Assistant Administrator revealed that several written warnings, including 30 day eviction notices have been issued to some clients in care for violating the house rules of suspected drug use, but not to the clients (C1, C2,C3) listed in the allegations. Based on record Review C1; C2; C3 have not been witnessed in the facility by staff using illegal drugs.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
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 2
Control Number 11-AS-20220211085342
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: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 02/15/2022
NARRATIVE
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In addition, the assistant Administrator has not received any complaints from any other clients regarding illegal drug use of the named clients. Administrator stated, that if they have suspicion of drug use for any client, they will do a thorough investigation. In the past Drug Paraphilia and weed have been found in client’s room during housekeeping; But not in the rooms of the clients named in the allegations. LPA was told by the Assistant Administrator that “Any client who is found with non-prescribed medication, not taking prescribed medication, alcohol, illegal drugs, or drug paraphernalia on the facility premises will be issued a written warning, and notified that their continuance can lead to an eviction.” Interviews with All Clients in care generally stated that they have not seen other clients using illegal drugs inside of the facility. During Physical plant Tour LPA observed that the facility has a camera facing an open alley. Although the alley is not part of the property line of the facility, the camera is being used for the safety of clients and staff. LPA did not observe on 02/15/22 any sale of illegal drugs to clients in care in an alley. Based on Interviews, Record Review and Physical Observation regarding the named clients, The Department finds that: “ Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. “

Regarding Allegation: Staff are not addressing residents' aggressive behavior

Interview with Assistant Administrator revealed that client (C3), who is named in the above allegation(s) is known to be verbally aggressive. C3 has not caused any physical damage to the facility, or physically assaulted any other clients in care. Administrator stated that” There is one Staff on night shift, and one on call. Staff have been instructed to contact 911, or local authorities, should aggressive behaviors take place, that staff cannot disengaged. Administrator stated that, “There have been one client in the last month, that has been placed on a 51/50 hold.” Interviews with Clients revealed that all generally stated there is one staff at night and have not witnessed any aggressive behavior at night by clients, resulting in holes in the walls of the facility. During Physical Tour LPA did not observe holes in the walls but did observe paint patches. Therefore; Based on Interviews, Record Review, And Observation. the Department finds that: “ Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. “

An Exit interview conducted and a copy of this report was provided. No citations were issued during this visit.

SUPERVISORS NAME: Michael Cava
LICENSING EVALUATOR NAME: Jade Jordan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2