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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603201
Report Date: 01/13/2022
Date Signed: 01/13/2022 01:56:07 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
01/06/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220106144824
FACILITY NAME:HEART TO HOME RESIDENTIAL FACILTYFACILITY NUMBER:
198603201
ADMINISTRATOR:MINES, JASMINEFACILITY TYPE:
735
ADDRESS:795 E ELIZABETH STTELEPHONE:
(626) 233-0725
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:6CENSUS: 3DATE:
01/13/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Hazel Lazaga, Administrator TIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Facility failed to return resident's personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegation. LPA met with Administrator, Hazel Lazaga who assisted with today's visit.

Regarding the allegation that the facility failed to return resident #1's personal belongings, the investigation consisted of Interview(s) with resident #1, and administrator, review of resident #1's file, and tour of resident #1's former room.

Administrator stated that resident #1 has not been at the facility since 12/29/21. She said that resident #1 is currently at a temporary facility and the facility does not have enough space to accommodate all of resident #1's belongings. Administrator stated that is the reason that they have not returned all of resident #1's personal belongings. Administrator also stated that the facility is working together with resident #1's Regional Center service coordinator, to ensure that resident #1's personal belongings are returned to him once he is in a permanent location. LPA toured resident #1's room, and observed that resident #1's belongings are in the room.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
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-20220106144824
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: HEART TO HOME RESIDENTIAL FACILTY
FACILITY NUMBER: 198603201
VISIT DATE: 01/13/2022
NARRATIVE
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Resident #1 acknowledged that his current location is unable to accommodate all of his personal belongings. Resident #1 stated that he has received some of his belongings from the facility, but not all of them due to the fact that he currently does not have enough space to store them. Resident #1 said that he picked up some of his belongings on 1/12/22, and facility staff also confirmed that. Resident #1 stated that his regional center coordinator said that he will be able to collect the remainder of his belongings once he is at a permanent location.

Based on LPA's observations and interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Hazel Lazaga
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2