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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602917
Report Date: 06/23/2022
Date Signed: 06/23/2022 04:14:50 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
02/09/2021 and conducted by Evaluator Valeria Maldonado
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210209093734
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:
06/23/2022
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Lupita Garcia- House ManagerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff speak inappropriately to resident in care.
Staff harassed resident in care.
INVESTIGATION FINDINGS:
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5
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Licensing Program Analyst (LPA) Valeria Maldonado conducted a subsequent visit regarding the above mentioned allegations and to deliver findings. LPA Maldonado met with house manager Lupita Garcia and explained the reason for the visit.

On 02/18/21, LPA Tao conducted an initial 10-day complaint visit via tele-conference and interviewed the facility administrator (S1) and clients #1-#4 (C1-C4). LPA Tao also requested copies of: Resident and Staff roster, and Physician's report, Identification and Emergency information, Appraisal, IPP, Progress report, Behavior ABC data forms (Dec 2020 to Feb 2021), Incident reports (Jan 2021 to Feb 2021), psychiatrist report, Placement Agency's observation note for verbal allegation; and Licensed Marriage Family Therapist report on how to cope with stress; all for C1. A copy of the placement agency's investigation was also obtained, dated: 02/10/2021.

(Report continued on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
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 2
Control Number 28-AS-20210209093734
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: 06/23/2022
NARRATIVE
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On 06/21/22 and 06/22/22, LPA Maldonado conducted telephone interviews with Staff #2-5 (S2-S5).
On 02/23/2022, LPA Maldonado made an unannounced visit to the facility to deliver findings, and met with house manager Lupita Garcia.

Allegation: Staff speak inappropriately to resident in care- During the interviews with C1-C4, the investigation revealed that (3) out of (4) clients stated they do not recall or have knowledge of said allegation occurring. C2-C4 state that staff treat them good and never speak inappropriately to them. During interviews conducted with S1-S5, (5) out of (5) staff stated they heard about an incident that occurred on or about 01/29/21 between C1 and S2, but did not witness the incident occur. S1-S5 stated they have never spoken inappropriately to any resident in care and help them with their needs. If they had witnessed other staff speaking inappropriately to a client, they would have reported it. Staff and resident interviews could not corroborate to this allegation. C1's placement agency also conducted an investigation regarding the allegation and conducted interviews with C1-C4, the alleged perpetrator, and additional staff in the facility. The placement agency's investigation did not provide any evidence to support the allegation.

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.

Allegation: Staff harassed resident in care- During the interviews with C1-C4, the investigation revealed that (3) out of (4) clients stated they have never felt, or have been harassed by staff in the facility, and do not recall said allegation occurring. C2-C4 stated that staff treat them good and never harassed them. During interviews conducted with S1-S5, (5) out of (5) staff stated they did not witness said allegation occur, nor have they ever harassed a client in care. Staff state if they had knowledge or were a witness to harassment of staff to clients, they would have reported it. Staff and resident interviews could not corroborate to this allegation. The placement agency's investigation did not provide any evidence to support the allegation.

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 with house manager and a copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Valeria Maldonado
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2