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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603013
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:50:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/02/2023 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230502105711
FACILITY NAME:ELWYN CALIFORNIA--ORANGE GROVEFACILITY NUMBER:
198603013
ADMINISTRATOR:VILLONDO, APRILFACILITY TYPE:
735
ADDRESS:14420 ORANGE GROVE AVENUETELEPHONE:
(626) 269-0892
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:4CENSUS: 4DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:April Villondo - Administrator TIME COMPLETED:
01:03 PM
ALLEGATION(S):
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Staff verbally abuses residents in care
Staff handles residents in a rough manner
Staff sprays chemicals in resident's faces
Staff throws water on residents
Staff inappropriately disciplines residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegation listed above. LPA met with the April Villondo the administrator of the facility and explained the reason of the visit.

The investigation consisted of the following: during the initial visit conducted on 05/08/2023, LPA Kruz Long obtained a copy of the Staff and Client rosters, interviewed Staff #1 - Staff #7 (S1 - S7), and interviewed Client #1 - Client #4 (C1 - C4). During today's visit, LPA Erik Zaragoza obtained a FACE Sheet for C1 - C4 and also a copy of the report from the San Gabrield/Pomona Regional Center's Quality Assurance department who investigated the same allegations.

The investigation revealed the following: In regards to the allegation that "Staff verbally abuses clients in care", it is alleged that C1 - C3 reported being verbally abused by S2 - S3 at the facility and had their rights withheld from them.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 6
Control Number 28-AS-20230502105711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ELWYN CALIFORNIA--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 10/12/2023
NARRATIVE
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During interviews with the clients, one (1) out of four (4) corroborated the allegation that they have been verbally harassed in the past, with C1 explaining that staff have yelled at them previously. During interviews with the staff, two (2) out of seven (7) interviewed stated that they have witnessed instances of verbal abuse between staff and clients occurring within the facility. S6 described instances in which the certain staff members had used foul language with clients and teased them , while the other staff members explained that there have been no instances of verbal abuse that have occurred within the facility. There were no Serious Incident Reports (SIRs) submitted to the department that corroborated this allegation. The Regional Center's Quality Assurance department's investigation found that this allegation was unsubstantiated.

Regarding the allegation that "Staff handles clients in a rough manner", it is alleged that two clients have expressed that they do not want to have their briefs changed by certain staff due to them being rough and mean with them during changing. During interviews with the clients, none of them corroborated the allegation that they have been treated in a rough manner by any of the staff members in the facility. During interviews with the staff, two (2) out of seven (7) corroborated the allegation that they have witnessed staff treating the clients roughly in the past. S7 explained that they witnessed another staff member pulling a diaper up on one of the clients in a rough manner while changing the client. All other staff members stated that they have never witnessed instances of other staff treated the clients in a rough manner. There were no SIRs submitted to the department that corroborated this allegation. The Regional Center's Quality Assurance department's investigation found that this allegation was unsubstantiated.

Regarding the allegation that "Staff sprays chemicals in client's faces", it is alleged that one of the staff members of the facility sprayed C1 in the face with Fabreeze during a brief change. During interviews with the clients, none of them corroborated the allegation that the staff have sprayed Fabreeze or any other chemicals in their face. During interviews with the staff, one (1) out of seven (7) corroborated the allegation that staff have sprayed chemicals in client's faces. S6 stated that they witnessed one of the staff members at various times spraying Fabreeze and cologne in the face of one of the clients as a form of punishment. None of the other staff members stated that other staff have sprayed chemicals in the faces of clients. There were no SIRs that submitted to the department that corroborated this allegation. The Regional Center's Quality Assurance department's investigation found that this allegation was unsubstantiated.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20230502105711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ELWYN CALIFORNIA--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 10/12/2023
NARRATIVE
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Regarding the allegation that "Staff throws water on the clients", it is alleged that certain staff have thrown water on clients to get back at them for bad behavior. During interviews with the clients, one (1) out of four (4) of them corroborated the allegation that they have had water thrown on them in the past. C1 explained that S3 has thrown a cup of water on him in the past. During interviews with the staff, none of them corroborated that they have ever witnessed any other staff member throwing water on the residents. There were no SIRs that submitted to the department that corroborated this allegation. The Regional Center's Quality Assurance department's investigation found that this allegation was unsubstantiated.

Regarding the allegation that "Staff inappropriately disciplines clients in care", it is alleged that staff have denied multiple outings to clients as well as snacks as a form of discipline. During interviews with the clients, none of them corroborated that they have been unfairly or inappropriately disciplined by any of the staff members in the past. During interviews with the staff members, two (2) out of seven (7) corroborated the allegation that staff have inappropriately disciplined the clients previously. S6 and S7 have stated that they have witnessed food being taken away from clients as a form of discipline, and refusing to assist them with their preferred activities. None of the other staff members explained that the facility has ever inappropriately disciplined the clients in the past. There were no SIRs that submitted to the department that corroborated this allegation. The Regional Center's Quality Assurance department's investigation found that this allegation was unsubstantiated.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported 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 above allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
05/02/2023 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230502105711

FACILITY NAME:ELWYN CALIFORNIA--ORANGE GROVEFACILITY NUMBER:
198603013
ADMINISTRATOR:VILLONDO, APRILFACILITY TYPE:
735
ADDRESS:14420 ORANGE GROVE AVENUETELEPHONE:
(626) 269-0892
CITY:HACIENDA HEIGHTSSTATE: CAZIP CODE:
91745
CAPACITY:4CENSUS: 4DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:April Villondo - Administrator TIME COMPLETED:
01:03 PM
ALLEGATION(S):
1
2
3
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5
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8
9
Staff are sleeping while on duty
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegation listed above. LPA met with the April Villondo the administrator of the facility and explained the reason of the visit.

The investigation consisted of the following: during the initial visit conducted on 05/08/2023, LPA Kruz Long obtained a copy of the Staff and Client rosters, interviewed Staff #1 - Staff #7 (S1 - S7), and interviewed Client #1 - Client #4 (C1 - C4). During today's visit, LPA Erik Zaragoza obtained a FACE Sheet for C1 - C4 and also a copy of the report from the San Gabrield/Pomona Regional Center's Quality Assurance department who investigated the same allegations.

The investigation revealed the following: In regards to the allegation that "Staff are Sleeping while on duty", it is alleged that staff members have been sleeping on scheduled shifts, and pictures allegedly depicted staff sleeping during scheduled shifts were provided to the regional office.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 6
Control Number 28-AS-20230502105711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ELWYN CALIFORNIA--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 10/12/2023
NARRATIVE
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During interviews with the clients, two (2) out of the four (4) clients corroborated the allegation that they have witnessed staff sleeping during scheduled shifts. Both C1 and C3 explained that they have witnessed separate staff members sleeping during the day. During interviews with the staff, three (3) out of (7) corroborated the allegation that staff members have slept at the facility while on duty. S4 explained that they did witness previous staff members sleeping during scheduled shifts in the past, however they no longer work at the facility. Additionally S6 and S7 both corroborated that they have witnessed various staff at the facility sleeping during scheduled shifts for up to 30 - 45 minutes at a time. The Regional Center's Quality Assurance department's investigation substantiated this allegation.

Based on LPAs interviews conducted with the residents and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099D.

Exit interview held and a copy of the report and appeal rights was provided to the administrator Logan Harrison.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20230502105711
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ELWYN CALIFORNIA--ORANGE GROVE
FACILITY NUMBER: 198603013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2023
Section Cited
CCR
80065(a)
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80065 (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

This requirement is not met as evidenced by:
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Administrator shall ensure that staff remain awake during scheduled work shifts at all times. Administrator is to submit a written plan indicating how the facility will meet regulation 80065(a) moving forward.
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Based on interviews and record review, LPA determined that varoius staff members had slept during scheduled work shifts, which poses a potential health and safety risk.
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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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6