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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603013
Report Date: 11/18/2024
Date Signed: 11/18/2024 02:36:07 PM

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
10/14/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241014105447
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:
11/18/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Staff Matt RiddellTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff are sleeping while on duty
INVESTIGATION FINDINGS:
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Licensing Program Analyst(s) (LPA) Jose Villalobos and Luis De Leon conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPAs met with staff Matt Riddell and the purpose of the visit was discussed.

The following was conducted between the initial visit on 10/22/24 and 11/18/24: LPA toured the physical plant of the facility, interviewed Staff #1-4 (S1-S4), interviewed clients #1-4 (C1-C4), interviewed placement agency (W1) for the clients, collected a copies of the staff and client rosters, and copies of documents from C1-C4s files related to the complaint allegations. The investigation revealed the following:

Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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
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
10/14/2024 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241014105447

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:
11/18/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Staff Matt RiddellTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Facility staff handles clients in a rough manner
Staff inappropriately disciplining client in care
Staff are not providing a safe environment for clients in care
Staff is using clients money for personal use
Facility failed to safeguard resident's belongings
Staff not providing clients medications as prescribed
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analyst(s) (LPA) Jose Villalobos and Luis De Leon conducted a subsequent complaint investigation visit for the allegation(s) listed above. LPAs met with staff Matt Riddell and the purpose of the visit was discussed.

The following was conducted between the initial visit on 10/22/24 and 11/18/24: LPA toured the physical plant of the facility, interviewed Staff #1-4 (S1-S4), interviewed clients #1-4 (C1-C4), interviewed placement agency (W1) for the clients, collected a copies of the staff and client rosters, and copies of documents from C1-C4s files related to the complaint allegations. The investigation revealed the following:


Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20241014105447
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--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 11/18/2024
NARRATIVE
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In regards to the allegation "Facility staff handles clients in a rough manner" it is alleged that staff #5(S5) shook C1's head aggressively out of frustration. (4) of (4) Staff interviewed denied the allegation. (4) of (4) clients in care could not corroborate the allegation. S5 no longer works in the facility and was unavailable for interview. C1 denied the incident ever occurred. LPAs did not observed any clients in care being handled in a rough manner by staff throughout the investigation. File review did not show any documentation of S5 shaking C1's head aggressively. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff inappropriately disciplining client in care" it is alleged that S4 showered C1 in cold water as punishment. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Staff interviewed could not corroborate the allegation. C1 denied that staff have showered them in cold water as punishment. S4 also denied showering C1 in cold water as punishment. File review did not show any documentation of staff inappropriately disciplining clients in care. LPAs did not observe clients in care being inappropriately punished by staff during the investigation. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff are not providing a safe environment for clients in care" it is alleged that staff are yelling at each other constantly around the clients, intoxicated while on shift and drive the facility vehicle recklessly. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Interview with clients did not show that they had any concern regarding staff allegedly yelling at each other, were not aware of any staff being intoxicated on shift, or had any problems with the way staff drive the facility vehicles. Staff interviewed denied that any of those allegations were occurring in the facility. LPA's did not observe any staff yelling at each other, being intoxicated on shift, or driving any vehicles recklessly throughout the investigation. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20241014105447
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--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 11/18/2024
NARRATIVE
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In regards to the allegation "Staff is using clients money for personal use" it is alleged that staff are using client personal funds to buy meals for themselves. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Staff interviewed stated to not be aware of any staff using clients money for their personal use. Clients interviewed were not aware of any staff possibly using their money for themselves either. LPA reviewed clients ledgers to be up to date. File review did not show any evidence of staff using client money for themselves. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Facility failed to safeguard resident's belongings" it is alleged that facility staff are using clients personal belongings for themselves. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Detail provided was that staff were using C3's clothing for personal use. C3 was unable to corroborate the allegation. Staff interviewed stated to not be aware of any staff using C3's clothing for themselves. File review did not show that any staff was documented to have been using C3's clothing. LPA's observed C3's clothing to be in their room. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

In regards to the allegation "Staff not providing clients medications as prescribed" it is alleged that there are medications errors in the facility. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Clients stated they receive their medications each day from staff on duty. LPA was not provided with specific dates of alleged medication error. LPA's reviewed medication administrator records (MAR) for all clients in care and did no observe any medication error. Based on interviews, file review, and observations conducted, 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 allegation is UNSUBSTANTIATED.

Exit Interview conducted and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20241014105447
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--ORANGE GROVE
FACILITY NUMBER: 198603013
VISIT DATE: 11/18/2024
NARRATIVE
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In regards to the allegation "Staff are sleeping while on duty" it is alleged that staff have been sleeping while on duty. (3) of (4) Staff interviewed denied knowledge of staff sleeping while on duty. (1) of (4) Staff interviewed corroborated that there were staff who slept while on duty but are no longer working in the facility. (3) of (4) Clients interviewed could not corroborate the allegation. (1) of (4) Clients corroborated the allegation. LPA reviewed Corrective Action Plan (CAP) completed by W1 dated 9/23/24 that substantiated facility staff were sleeping while on shift. LPA interviewed W1 and confirmed that the agency had corroborating interviews as well as photographic evidence that facility staff were sleeping while on duty. The times that staff were sleeping were during late night and the noc shifts. This shows that the facility staff were not competent to provide the services necessary to meet individual client needs because they would sleep during their shifts. Based on LPAs interviews conducted, files reviewed, and observations, the preponderance of evidence standard has been met; 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 were provided and discussed.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20241014105447
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--ORANGE GROVE
FACILITY NUMBER: 198603013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2024
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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Facility has completed in service trainings and has followed Corrective Action Plan Set by regional center. LPA verified completed tasks. Facility has also had a change in staff to correct staffing issues.
Deficiency is cleared at the time of visit.
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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: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6