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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602856
Report Date: 07/03/2025
Date Signed: 07/03/2025 03:17:35 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
COMPLAINT CONTROL NUMBER: 11-AS-20250415163546
FACILITY NAME:EASTERSEALS SOUTHERN CALIFORNIA-KALLIN RESIDENCEFACILITY NUMBER:
198602856
ADMINISTRATOR:DRUMMOND, MARIAFACILITY TYPE:
735
ADDRESS:824 KALLIN AVETELEPHONE:
(818) 512-2494
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:3CENSUS: 3DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
12:34 PM
MET WITH:Alex HerandezTIME COMPLETED:
03:30 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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*This report serves to clarify investigation findings and has been created to supersede the LIC 9099 and LIC 9099C reports created on 04/21/25. Although this report supersedes the previous report, the complaint investigation findings remain the same. *
On July 3, 2025 Licensing Program Analyst (LPA) Deborah Lee conducted a subsequent complaint visit to clarify and to deliver findings. LPA met with Administrator Alex Hernandez, and the purpose of the visit was explained.
Investigation consisted of the following:
On April 21, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an initial 10-day visit to gather information regarding the above allegations. 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).
On 7/2/25, LPA conducted 3 staff interviews (S6-S8) via telephone.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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 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: 07/03/2025
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 C1 being aware and said, "come on we're going to bathroom." The client started yelling "no no I don't wanna go". S1 allegedly 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 allegation and stated he 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. 1 out of 5 staff state that they have witnessed another staff handling client in a rough manner. On April 21, 2025, LPA attempted interviews with 3 clients (S1-S3) 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 likes living there and if staff is kind to them 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.

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 341A) which confirms that staff had training on the treatment of clients, and that they are aware of how to report suspected abuse.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 07/03/2025
NARRATIVE
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On July 2, 2025, LPA Lee conducted 3 staff interviews (S6-S8)via telephone regarding the allegation, and of those interviewed, (3) out (3) denied the allegation stating they treat the clients with respect and dignity and have never treated the clients in a rough manner. 3 out of 3 staff stated they have not witnessed any other staff handling clients in a rough manner. 3 out of 3 stated that they would report any incidents of abuse had they witnessed it.

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.

On July 2, 2025, LPA Lee conducted 3 staff interviews (S6-S8) via telephone regarding the allegation, and of those interviewed, (3) out (3) denied the allegation stating they have never isolated a client nor have they witnessed any other staff member isolating a client. 3 out of 3 staff interviewed stated that they would have reported the incident if they had witnessed it.

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

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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: 07/03/2025
NARRATIVE
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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 Alex Hernandez, Administrator.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4