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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 08/26/2022
Date Signed: 08/26/2022 02:10:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
08/24/2022 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220824105105
FACILITY NAME:LONG BEACH RESIDENTIALFACILITY NUMBER:
198602620
ADMINISTRATOR:CRYSTAL BARRIENTOSFACILITY TYPE:
735
ADDRESS:4201 EAST 10TH STREETTELEPHONE:
(562) 433-2455
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:49CENSUS: 47DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Crystal BarrientosTIME COMPLETED:
02:37 PM
ALLEGATION(S):
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Staff is discriminating towards the resident.
INVESTIGATION FINDINGS:
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On 08/26/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility, LPA was greeted by administrator Crystal Barrientos. LPA explained the purpose of today's inspection visit and to collect information and deliver findings.

The investigation consisted of the following: A review of the roster for clients and staff. A review of client #1 (C1's) service records. Interviews with staff #1-#3 (S1-S3), clients #1-#7 (C1-C7), and reporting party. An inspection of the entire facility was conducted.

Evaluation Report continues on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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-20220824105105
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 08/26/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff is discriminating towards the resident.

The details on this complaint state client #1 (C1) is discriminated against by staff. The complainant reported on 08/22/22 the facility issued a 30-day Notice to Vacate and believes the facility staff discriminates.

The Department interviewed the complainant who recanted his original statements he provided with the Centralized Complaint and Information Bureau (CCIB) on 08/24/22 stating there are no issues and he had no further comments on the matter. Interviews conducted with (C1) describes the living condition at this facility is safe and pleasant. (C1) asserted that no type of inappropriate or offensive behavior from staff that would constitute some type of discrimination. (C1) added that he was not served with any Notice to Vacate this facility. Interviews with clients #2-#7 (C2-C7) are in complete agreement that the facility provides a safe and satisfactory setting for residents and that they have no knowledge of any type of discrimination. (C1-C7) expressed that the facility has House Rules to keep the residents in order to prevent any inappropriate behavior. Interviews with staff #1-#3 (S1-S3) claim this allegation is false. (S1) reports the facility has a zero-tolerance policy implemented to prevent any unacceptable behavior. (S1) verifies that there is not 30-day Notice to Vacate issued to (C1).

Based on information gathered, an inspection of the facility, observation, analysis of (C1)'s service records, and interviews conducted, the Department found no evidence to support the allegation mentioned in this complaint.

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.

No deficiencies were cited during this visit.

An exit interview was conducted with Crystal Barrientos, and a copy of the report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2