198603229-12-27-2022-28-AS-RORN-CPBNF7-20230223092503

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603229
Report Date: 12/27/2022
Date Signed: 12/27/2022 04:27:59 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
12/12/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221212142658

FACILITY NAME:	MERCEDES DIAZ HOMES, INC. - EVELYN HOME		FACILITY NUMBER:	198603229
ADMINISTRATOR:	GRISELDA ELAIR		FACILITY TYPE:	735
ADDRESS:	2507 EVELYN AVE		TELEPHONE:	(626) 872-0236
CITY:	ROSEMEAD	STATE: CA	ZIP CODE:	91770
CAPACITY:	4	CENSUS: 4	DATE:	12/27/2022
		UNANNOUNCED	TIME BEGAN:	03:32 PM
MET WITH:	Elvia Rojas, House Manager		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff hit Client.
Staff did not treat client with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit for the allegations listed above. LPA arrived unannounced and met with House Manager, Elvia Rojas. The purpose of the visit was explained.

The investigation consisted of the following:
On 12/19/22, LPA Chan conducted the initial visit and obtained the staff roster, client roster, and documents pertaining to Client #1. LPA also reviewed Staff files. Interviews were held with 6 Staff (S1 - S6) and 3 Clients (C1 - C3). Client #4 was non-verbal and did not respond to LPA.

The investigation revealed the following:
Allegation – Staff hit client. It is alleged that Staff #1 (S1) hit Client #1 (C1) with a spatula because the client was having a behavior. LPA interviewed S1 who denied hitting C1.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

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-20221212142658

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: MERCEDES DIAZ HOMES, INC. - EVELYN HOME	FACILITY NUMBER: 198603229
	VISIT DATE: 12/27/2022

NARRATIVE

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S1 indicated that a spatula was used to seek the attention of C1 by hitting it against the wall but not directly at client, due to C1 exhibiting a behavior. The Administrator did not hear about this incident from any staff or client and was only made aware of this from LPA notification. Administrator stated that there is a zero tolerance policy and would have conducted an internal investigation and take disciplinary action if necessary. The other staff interviewed were not aware of nor have seen any staff hitting a client. They acknowledged that S1 had used a spatula by hitting against the wall or table to seek C1's attention but never to hit C1. Staff also mentioned that they are mandated reporters and will report any abuse they see. LPA interviewed 3 Clients on 12/19/22. C1 stated that S1 had hit him/her but did not provide any additional details. The other 2 clients stated that S1 nor any other staff had hit them before. LPA reviewed C1's Individual Program Plan and there was an indication of monitoring client for "making allegations defined as stating that another person physically or emotionally abused or neglected their needs." There was no sufficient evidence to prove this allegation had happened.

Allegation – Staff did not treat client with dignity and respect. It is alleged that a staff pointed a bottle of cleaner in Client #1’s face after C-1 cleaned up the floor. LPA interviewed the Administrator and 6 Staff. The Administrator was not aware of this incident. One of the staff acknowledged that C1 was asked to clean up the spit on the floor but denied pointing a bottle of cleaner in client's face afterwards. Staff stated that when a client makes a mess or even after meals, they are requested to assist with cleaning after themselves to teach them responsibility. Afterwards, they will verbally praise them to reinforce good behavior. Staff interviewed all stated they treat clients with dignity and respect. They treat them like family and will talk to them firmly if needed but not in a disrespectful way. They also have not witnessed any staff mistreating a client.

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, Elvia Rojas. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

LIC9099 (FAS) - (06/04)

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