198603217-10-11-2021-28-AS-CYEE-C864NZ-20211025191557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603217
Report Date: 08/11/2021
Date Signed: 10/11/2021 02:00:05 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
08/09/2021 and conducted by Evaluator Alberto Lopez

COMPLAINT CONTROL NUMBER: 28-AS-20210809112045

FACILITY NAME:	DEL SOL HOME (CARPINTERO)		FACILITY NUMBER:	198603217
ADMINISTRATOR:	GONZALES, MERCI		FACILITY TYPE:	735
ADDRESS:	17926 CARPINTERO AVE		TELEPHONE:	(562) 243-4234
CITY:	BELLFLOWER	STATE: CA	ZIP CODE:	90706
CAPACITY:	4	CENSUS: 2	DATE:	08/11/2021
		UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Merci Gonzales		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff ignoring resident's.

INVESTIGATION FINDINGS:

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Report has been amended to remove Client's diagnosis information.

Licensing Program Analyst (LPAs) Alberto Lopez and Christine Wong conducted an initial 10-day complaint investigation at the facility. LPAs met with Jorgelle Catunao (Co-Administrator) and explained the reason for today's visit. Shortly after Administrator Merci Gonzales arrived.

The investigation consists of the following: LPAs interviewed Administrator, Co-administrator and one staff (S1) in the facility and three staff (S2-S4) on the phone. LPAs also interviewed two (2) clients (C1-C2). Also, LPA obtained documents including CI and C2 face sheet, Individual Person-Centered Plan (IPP), Client Development and Evaluation Report (CDER), behavior logs and C2's medical record, staff and client roster, facility schedule and the receipt of door alarm.

The investigation revealed of the following: Allegation "Staff ignoring residents." During the interview, two staff stated that they tend to client's needs right away when clients called or need assistance.

(Please see LIC 9099C for contination)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210809112045

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: DEL SOL HOME (CARPINTERO)	FACILITY NUMBER: 198603217
	VISIT DATE: 08/11/2021

NARRATIVE

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Administrator and Co-Administrator also stated that they care for clients on a timely basis. LPA interviewed clients and reported one client does scream and yell sometimes but not too long and staff would address it right away. Client reported never hearing any door alarm go on. One client has antecedent behavior which cause yelling or screaming. Staff reported the screaming or yelling usually occurs for maximum of two minutes when client is experiencing symptoms of medical condition or need. Staff reported that the screaming or yelling is always addressed right away by redirecting client or providing what client may need at the time. Administrator also indicated that medication was recently adjusted for the medical condition. Staff reported that facility recently purchased three new window/door alarms (two for the back-sliding doors and one for the front entrance) due to one client who has a history of eloping/AWOL. Staff stated that alarms are only turn on at night and goes on only when door is opened. Staff stated they do not go outside at night, so the alarm is not sounding on at all hours of the day and night. Two staff stated that if on break and resident’s require assistance, they will interrupt their breaks and help the clients. All staff interviewed stated they are aware of the time that residents go to bed and provided a time which was consistent with other staff. This indicates that staff are attentive to clients.

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.

Exit Interview Conducted. A copy of the report and appeal right was provided to administrator Merci Gonzales.

NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/11/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021

LIC9099 (FAS) - (06/04)

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