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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602917
Report Date: 11/01/2021
Date Signed: 11/01/2021 03:29:40 PM

Unsubstantiated


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
04/07/2020 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200407134401
FACILITY NAME:ELWYN CALIFORNIA-RANCHO LINDOFACILITY NUMBER:
198602917
ADMINISTRATOR:VILLONDO, APRILFACILITY TYPE:
735
ADDRESS:527 S RANCHO LINDO DRIVETELEPHONE:
(626) 257-3201
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:4CENSUS: 4DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Gabriela BeltranTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff member inappropriately touched client.
Staff inappropriately handled client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted a subsequent visit for the above allegations and deliver the findings today. LPA was greeted by staff, Gabriela Beltran and explained the reason of the visit.

The investigation consisted of the following: On 04/15/20, LPA Irra conducted an initial 10 days complaint via tele-conference and interviewed the Facility Administrator. LPA Irra also requested copies of: Copy of Staff and Client Roster with contact information, Client #1 (C-1) Individual Program Plan (IPP), most recent quarterly report, behavioral reports, daily notes, physician report, Special Incident Report (SIR) and any investigative reports. Additionally, for staff, Facility Administrator to submit the following for Staff #1 through Staff #3 (S-1 through S-3): documentation of action taken regarding this incident, staff schedule for March 2020 & April 2020, training on Mandated Reporting, training on Zero Tolerance and training on Clients Rights. On 10/18/2021, LPA Wong conducted a follow up complaint visit in the facility and interviewed four clients (C1-C4), three staff (S1-S3) in the facility and conducted a telephone interview with facility administrator and interviewed three additional staff via phone. (See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
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 5
Control Number 28-AS-20200407134401
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-RANCHO LINDO
FACILITY NUMBER: 198602917
VISIT DATE: 11/01/2021
NARRATIVE
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The investigation revealed of the following: Allegation#1 “Staff member inappropriately touched client.” LPA interviewed four clients and all denied the allegation. They reported they never seen or witnessed any staff inappropriately touched the client. They reported its never happened in the facility. LPA interviewed staff and all denied the allegation. All staff stated that they never witnessed or seen any staff inappropriately touched the client.

In regard to Allegation#2 “Staff inappropriately handled client. “LPA interviewed clients, and all denied the allegation and reported there’s no staff ever inappropriately handled the client. All staff are handling them well. LPA interviewed staff and all staff denied the allegation. Staff reported no staff ever being rough or physically abused the client purposely. They never witnessed any staff inappropriately handled the clients.

Based on statements and interviews conducted with staff and clients and documents reviewed, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

Exit Interview was conducted and a copy of the report and an appeal right was provided to the staff Gabriela Beltran.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
04/07/2020 and conducted by Evaluator Christine Wong
COMPLAINT CONTROL NUMBER: 28-AS-20200407134401

FACILITY NAME:ELWYN CALIFORNIA-RANCHO LINDOFACILITY NUMBER:
198602917
ADMINISTRATOR:VILLONDO, APRILFACILITY TYPE:
735
ADDRESS:527 S RANCHO LINDO DRIVETELEPHONE:
(626) 257-3201
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:4CENSUS: 4DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Gabriela BeltranTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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2
3
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9
Staff member inappropriately spoke to client.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Christine Wong conducted a subsequent visit for the above allegations and deliver the findings. LPA was greeted by staff-Gabriela Beltran and explained the reason of the visit.

The investigation consisted of the following: On 04/15/20, LPA Irra conducted an initial 10 days complaint via tele-conference and interviewed the Facility Administrator. LPA Irra also requested copies of: Copy of Staff and Client Roster with contact information, Client #1 (C-1) Individual Program Plan (IPP), most recent quarterly report, behavioral reports, daily notes, physician report, Special Incident Report (SIR) and any investigative reports. Additionally, for staff, Facility Administrator to submit the following for Staff #1 through Staff #3 (S-1 through S-3): documentation of action taken regarding this incident, staff schedule for March 2020 & April 2020, training on Mandated Reporting, training on Zero Tolerance and training on Clients Rights. On 10/18/2021, LPA Wong conducted a follow up complaint visit in the facility and interviewed four clients (C1-C4), three staff (S1-S3) in the facility and conducted a telephone interview with facility administrator and three additional staff via phone. (See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20200407134401
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-RANCHO LINDO
FACILITY NUMBER: 198602917
VISIT DATE: 11/01/2021
NARRATIVE
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The investigation revealed of the following: Allegation “Staff member inappropriately spoke to client.” LPA interviewed four clients and three clients reported staff members spoke inappropriately to them. Although clients reported the staff who spoke inappropriately already left the facility and no longer working in the facility. Clients reported that staff would yell and scream at them, call them names or giving them finger. LPA interviewed staff and they all denied the allegation. Staff reported they never witnessed any staff inappropriately spoke to the clients. According to the administrator and staff, they were having a quarterly meeting with Regional Center on zoom for client, one of the staff tried to turn off one client television which triggered the behavior of the client and client started yelling and screaming. The staff expressed to client that not want to work with the client anymore and everyone was heard the conversation during the zoom meeting.

Based on interviews conducted with client and staff and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED The deficiency is cited on the attached LIC 9099D

Exit interview held. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20200407134401
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-RANCHO LINDO
FACILITY NUMBER: 198602917
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2021
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights (a)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. The requirement is not met as evidenced:
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The administrator will ensure each client shall have personal right to be accorded diginity in his/her personal relationship with staff. The administrator will re-train staff for personal right and send the training log to LPA by POC due date
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By LPA's interviews, three out of four clients reported the staff are inappropriately spoke to them which posed a potiential risk of residents
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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: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5