198602856-4-21-2025-11-AS-EMAZ-DJUSZE-20250723141858

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602856
Report Date: 04/21/2025
Date Signed: 04/21/2025 03:27:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/15/2025 and conducted by Evaluator Deborah Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250415163546

FACILITY NAME:	EASTERSEALS SOUTHERN CALIFORNIA-KALLIN RESIDENCE		FACILITY NUMBER:	198602856
ADMINISTRATOR:	DRUMMOND, MARIA		FACILITY TYPE:	735
ADDRESS:	824 KALLIN AVE		TELEPHONE:	(818) 512-2494
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	3	CENSUS: 3	DATE:	04/21/2025
		UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Alejandro Hernandez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff does not treat resident with respect and dignity.
Staff isolated resident in the dark.

INVESTIGATION FINDINGS:

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On April 21, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an initial 10-day visit to gather information regarding the above allegation(s). LPA met with Alejandro Hernandez, Administrator and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following: On April 21, 2025, LPA Lee obtained and reviewed the following documents: Client Roster (dated 8/26/24), staff roster (dated 4/21/25), Staff training on Protocol, Policies; code of conduct/behavior in workplace (dated: 3/27/25, 4/15/25) Clients Rights via Relias, Physicians Report for Clients #1-3 (C1-C3) dated 1/8/25, 1/7/25, 9/12/24, signed acknowledgement of Suspected Elder abuse (SOC 341A) for S1-S5, Individual Program Plans (IPP) for C1-C3) dated 9/4/24, 8/1/24, 6/13/24 and Appraisal/Needs and Service plan for S1-S3 (dated 8/12/24, 10/11/21, and 3/1/19). LPA Lee interviewed Administrator (A1), 3 clients (C1-C3), and 5 staff (S1- S5).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

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-20250415163546

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: EASTERSEALS SOUTHERN CALIFORNIA-KALLIN RESIDENCE	FACILITY NUMBER: 198602856
	VISIT DATE: 04/21/2025

NARRATIVE

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Investigation revealed the following:

Allegation: Staff does not treat resident with respect and dignity.

The detail of the complaint alleges that S1 grabbed the handles of C1’s wheelchair without him being aware and said, "come on we're going to bathroom." The client started yelling "no no I don't wanna go". The staff said "no you're going to the bathroom so I can change you. Additionally, it is alleged that S1 told C1 that “You’re not wearing those pants on my shift.” On April 21. 2025, between 9:00am and 10:30am, LPA Lee interviewed Administrator (A1) who denied the allegations and stated he has assumed the role of Administration as of February 2025 and he was not aware of any reports of staff not treating clients with dignity and respect. On April 21, 2025 between 10:30am and 2:30pm, LPA Lee interview 5 staff (S1-S5) regarding the allegation, and of those interviewed, (4) out (5) denied the allegation stating they always treat the clients with respect and dignity and have not treated the clients in a rough manner nor have they witnessed any other staff handling clients in a rough manner. On April 21, 2025, LPA attempted interviews with 3 client regarding the allegation of the those interviewed, 2 of the 3 were unable to communicate in a meaningful way to answer LPA’s questions. 1 out of 3 was able to shake head “yes” when asked if they he likes living there and if staff is kind to him and treats them "nice." The review of the Individual Program Plan (IPP) confirms that 1 of 3 clients is non-verbal, and 1 of 3 clients can follow simple commands on occasion.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250415163546

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: EASTERSEALS SOUTHERN CALIFORNIA-KALLIN RESIDENCE	FACILITY NUMBER: 198602856
	VISIT DATE: 04/21/2025

NARRATIVE

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On April 21, 2025, LPA Lee reviewed the following: staff training on Protocol, Policies; code of conduct/behavior in workplace (dated: 3/27/25, 4/15/25), Clients Rights via Relias, and signed acknowledgement of Suspected Elder abuse (SOC 441A) which confirms that staff had training on the treatment of clients, and that they are aware of how to report suspected abuse.

Allegation: Staff isolated resident in the dark.

The detail of the complaint alleges that S1 placed C1 in his room in the dark. On April 21. 2025, between 9:00 and 10:30am , LPA Lee interviewed Administrator (A1) who denied the allegation and stated that upon assuming the role of Administrator, he is unaware of the above-mentioned allegation. On April 21, 2025, LPA Lee interview 5 staff (S1-S5) regarding the allegation, and of those interviewed, (5) out (5) denied the allegation stating they have never isolated a client and 4 out 5 stated that they have never witnessed any other staff isolating a client. On April 21, 2025 LPA attempted to interview 3 clients regarding the allegation and of those attempted interviews (3) out of (3) were unable to answer LPA’s questions in a meaningful way.

Based on the information gathered, there is insufficient evidence to support the stated allegation

Although the allegations above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED

No deficiencies were cited for the above allegations. Exit interview was conducted. A copy of this report was provided to Alejandro Hernandez, Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2025

LIC9099 (FAS) - (06/04)

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