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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602917
Report Date: 11/22/2021
Date Signed: 11/22/2021 11:42:46 AM

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
09/17/2021 and conducted by Evaluator LaJean Nicole Spencer
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210917160512
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:
11/22/2021
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Lupita Garcia, House ManagerTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff verbally abused a client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent visit to deliver the findings for the allegation listed above. LPA Spencer met with Lupita Garcia, the house manager and explained the purpose of today’s visit.

The investigation consisted of the following: During the initial investigation on 9/24/21, LPA Spencer toured the physical plant and interviewed the administrator, staff #1-3 (S1-S3), and clients #1-4 (C1-C4). LPA obtained copies of the staff roster, client roster, and staff training records. During the course of the investigation, LPA telephonically interviewed staff #4-5 (S4-S5). S4 was unable to be reached because phone number was no longer in service. During today's visit, LPA Spencer conducted a follow-up interview with the administrator and obtained incident report dated 7/30/21, facility's internal investigation report, and the placement agency's investigation report.

***See LIC9099C for continuation of this narrative***
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
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 3
Control Number 28-AS-20210917160512
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: 11/22/2021
NARRATIVE
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The investigation revealed the following:

Staff verbally abused a client while in care

Interviews revealed: Three (3) out of four (4) clients interviewed stated that they have experienced and witnessed staff verbally abusing clients in care, including using inappropriate names, language, and tone of voice. One (1) of four (4) staff stated that they have witnessed a staff verbally abusing a client, while three (3) out of four (4) staff denied knowledge of this. The administrator stated that she has not personally witnessed any staff verbally abuse clients but stated that the facility is doing their own internal investigation regarding this allegation. In a follow-up interview on 11/22/21, the administrator stated that the internal investigation substantiated the allegation and the staff member in question was terminated.

A review of the records revealed: Incident report dated 7/30/21 states that on 7/29/21 a staff member witnessed a staff making inappropriate comments towards a client and reported it to human resources. The incident report states that the alleged perpetrator was placed on temporary leave pending the investigation. The facility's internal investigation dated 9/9/21 substantiated the allegation that a staff verbally abused a client in care based upon interviews conducted. A report from the placement agency dated 9/17/21 showed unsubstantiated findings. However, as the facility's internal investigation report states, the client was quiet and did not answer the questions with the placement agency's investigator and went into more detail during the interviews with the internal investigator.

Based on LPA’s interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, is being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report was provided to the administrator and house manager along with the Appeals Rights.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20210917160512
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: 11/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/23/2021
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights: 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 was not met as evidenced by...
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The administrator stated that the staff member was terminated on 10/1/21 and she will provide CCL with a copy of the termination letter by POC due date. In addition, facility will conduct in-service staff training for staff on client personal rights and abuse reporting and provide CCL with copy of training logs by POC due date.
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Based upon interviews and records reviewed, the licensee did not ensure that three out of four clients were accorded dignity and respect in their personal relationships with staff.
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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: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3