198602916-9-27-2025-28-AS-LHIS-DM3UXK-20251002155829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602916
Report Date: 09/27/2025
Date Signed: 09/27/2025 12:39:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
08/13/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250813152639

FACILITY NAME:	CASA KLINEDALE		FACILITY NUMBER:	198602916
ADMINISTRATOR:	MENENDEZ, SAMIRA		FACILITY TYPE:	735
ADDRESS:	9243 KLINEDALE AVENUE		TELEPHONE:	(562) 440-7531
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90240
CAPACITY:	4	CENSUS: 4	DATE:	09/27/2025
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	DSP Liz Curiel		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff denied resident access to the facility.
Staff did not respect resident’s right to make personal choices.
Licensee did not ensure sufficient staffing to meet resident care needs.
Staff caused injury to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Liz Curiel DSP worker who assisted with today’s visit. Administrator Samira Menedez was notified

The investigation consisted of the following: During the initial visit conducted on 08/18/2025, LPA interviewed Administrator, obtained copies of the following documents: staff roster, client roster, Downey PD business card, C1’s identification sheet, physicians report, appraisal needs and service plan, IPP report, and SIR pertaining to day program. During visit on 09/23/2025 LPA Gutierrez interviewed staff #1-staff#2, residents #1-residents #2 (residents R3 R4 are nonverbal), and obtained facility notes. On 09/26/2025 LPA interviewed by telephone staff 3-staff 4. During today’s visit LPA Gutierrez delivered findings.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025

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 28-AS-20250813152639

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CASA KLINEDALE	FACILITY NUMBER: 198602916
	VISIT DATE: 09/27/2025

NARRATIVE

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In regard to the allegation “Staff denied resident access to the facility.”, it is alleged that staff will not know allow clients to come home from program early because there are no staff present during the hours of program. During interviews with staff five (5) out of five (5) staff stated that schedules are always changed to meet the demand of the clients. Interview with administrator revealed that there are enough staff employed to call someone to go in early or stay later. Administrator stated that there have been times when she stays home with a client. All staff stated that no resident has ever been denied the right to come home. During interviews with clients two (2) out of four (4) (2 nonverbal clients) stated that they have never had any problems with coming home early from program.

In regard to the allegation “Staff did not respect resident’s right to make personal choices”, it is alleged that staff will not let a client staff home from program if they chose to. During interviews with staff five (5) out of five (5) staff stated that all clients have the choice to stay home. S2 presented LPA a log facility keeps when clients are ill or just choose not to attend program. LPA observed C1 at home on the day of visit because of his/her choice not to attend program that day. During interviews with clients two (2) out of four (4) clients (2 nonverbal clients) stated that they can stay home if they want to. C1 stated he/she does not like the program they attend and wants to go to a different one.

In regard to the allegation “Licensee did not ensure sufficient staffing to meet resident care needs.” it is alleged that there is no staff at residence during the day. During interviews with staff five (5) out of five (5) staff stated that there are no staff scheduled during the day because all four clients go to day program. All staff stated that if needed arrangements will be made for a staff member to be present due to a client staying home. LPA asked all staff if they felt there were enough staff employed at residence and all stated yes.

In regard to the allegation “Staff caused injury to resident.”, it is alleged that staff pinched clients leaving bruises on arm. During interviews with staff five (5) out of five (5) staff stated that clients have never been pinched by any staff. S5 stated that if they ever were to see staff pinching a client, they wouldn’t be working there anymore. During interviews with clients two (2) out of four (4) clients (2 nonverbal clients) stated that they have never been pinched, hit, or been physically abused by any staff at home. When asked by LPA if they ever had bruises on arms from staff both clients stated no.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report was provided by email.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2025

LIC9099 (FAS) - (06/04)

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