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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602891
Report Date: 04/24/2025
Date Signed: 04/24/2025 03:21:34 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
03/21/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250321153120
FACILITY NAME:ELWYN CALIFORNIA - EL MONTEFACILITY NUMBER:
198602891
ADMINISTRATOR:ADALID SOLANO GUTIERREZFACILITY TYPE:
735
ADDRESS:12052 CONFERENCE STTELEPHONE:
(626) 672-0248
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:4CENSUS: 4DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:LVN Xuexiang WuTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff prevented client from using the bathroom leading client to defecate self
Staff left client in feces for extended time.
Staff threaten client
INVESTIGATION FINDINGS:
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The purpose of the visit today 04/24/25 is to change the deficiency type and correct the POC date.
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff S3 and explained the reason for the visit.
The purpose of the visit is to investigate the above allegations.
At today's visit the following occurred:
Resident and Staff Roster submitted.
Interview was conducted with the Administrator telephonically and Staff S1, and Staff S2 were interviewed telephonically and Staff S3 was interviewed at the facility.
Client C1 was interviewed. Special Incident Reports (SIR's) submitted.
Client C2 was unable to be interviewed because he is non-verbal and unable to respond to questioning.
In regards to the allegation Staff prevented client from using the bathroom leading client to defecate self, based on interviews conducted and information gathered Corrective Action Plan (CAP) by the San Gabriel Pomona Regional Center was issued on 03/21/25 which delivered Substantiated findings regarding
violation of consumers rights.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 28-AS-20250321153120
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: ELWYN CALIFORNIA - EL MONTE
FACILITY NUMBER: 198602891
VISIT DATE: 04/24/2025
NARRATIVE
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Administrator confirmed that a Corrective Action Plan regarding personal rights is being complied to by the facility.
Interviews with Staff S2-S3 who stated that Client C2 was left in feces and they smelled poop from outside his room.
Stated that Staff S1 prevented Client 1 from using the bathroom leading client to defecate self.
Said Client C2 is being stopped because he is going in his room and is peeing in the closet.
Believe Client C2 is scared of Staff S1 not letting him go to the bathroom and came out distraught and shaking and increasing self injurious behaviors.
Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22) cited on the attached 9099 D.
In regards to the allegation Staff left client in feces for extended time, based on interviews conducted and information gathered Corrective Action Plan (CAP) by the San Gabriel Pomona Regional Center was issued on 03/21/25 which delivered Substantiated findings regarding violation of consumers rights.
Interviews with Staff S2-S3 who all stated that Staff S1 had entered Client C2's room and he was not changed with there being a poop odor outside his room for approximately 30 minutes until Staff S1 went back into Client C2's room.
Administrator stated that she was aware of Substantiated finding by Regional Center in which Client C2 was stopped from going to the restroom and had feces for 30 minutes.
Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22) cited on the attached 9099 D.
In regards to the allegation staff threaten resident based on interviews conducted and information gathered Corrective Action Plan (CAP) by the San Gabriel Pomona Regional Center was issued on 03/21/25 which delivered Substantiated findings regarding violation of consumers rights.
Interviews with Staff S2-S3 who stated that Staff S1 lifted his sandal toward Client C2 in a threatening gesture and a loud bang was heard from Client C2's room which sounded like toys thrown around.
Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22) cited on the attached 9099 D.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20250321153120
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: ELWYN CALIFORNIA - EL MONTE
FACILITY NUMBER: 198602891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/25/2025
Section Cited
CCR
80072(a)(1)
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Personal Rights
Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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Administrator will schedule a training with all staff on clients’ rights and abuse reporting in
and submit a signed log of those who attend by POC due date.

Deficiency previously cleared on 03/28/25.
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Based on interviews conducted and information gathered the licensee failed to accord Client C2 dignity in his/her personal relationships with staff and other persons
which which poses an immediate health, safety or personal rights risk to persons in care.
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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.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 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
03/21/2025 and conducted by Evaluator Glenn Trueman
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250321153120

FACILITY NAME:ELWYN CALIFORNIA - EL MONTEFACILITY NUMBER:
198602891
ADMINISTRATOR:ADALID SOLANO GUTIERREZFACILITY TYPE:
735
ADDRESS:12052 CONFERENCE STTELEPHONE:
(626) 672-0248
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY:4CENSUS: 4DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:LVN Xuexiang WuTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff yelled at client
INVESTIGATION FINDINGS:
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In regards to the allegation Staff yelled at client, based on interviews conducted and information gathered Client C1 stated she had not heard Staff S1 yelling at Client C2.
Administrator stated that Staff S1 has a strong accent but not yelling.
Staff S2-S3 stated Staff S1 was not yelling, but has a strong loud voice.
Staff S1 said he has worked with Client C2 since 2018 and never yells at him.

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.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4