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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603275
Report Date: 08/22/2024
Date Signed: 08/22/2024 04:04:45 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
08/13/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240813125404
FACILITY NAME:FLYNN HOME CARE INCFACILITY NUMBER:
198603275
ADMINISTRATOR:AUCIONE COELHO EVEFACILITY TYPE:
735
ADDRESS:7153 CULLY AVETELEPHONE:
(562) 395-8118
CITY:WHITTIERSTATE: CAZIP CODE:
90606
CAPACITY:4CENSUS: 4DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Ninfa AguileraTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff are not providing adequate supervision to a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an initial complaint visit to investigate the above allegation. LPA met with Ninfa Aguilera. Shortly after Administrator Leslie Eve arrived. LPA explained the purpose of today's visit.

During today's visit, LPA obtained a copy of the staff roster and client roster. LPA reviewed Client 1's (C1) file and obtained relevant documentation. LPA also interviewed C1, Administrator, Staff 1 through Staff 3 (S1 through S3) and Roman Empire Living Skills Educator. S2 and S3 interviewed over the phone.

Cont. 9099C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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 2
Control Number 28-AS-20240813125404
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: FLYNN HOME CARE INC
FACILITY NUMBER: 198603275
VISIT DATE: 08/22/2024
NARRATIVE
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Allegation: Staff are not providing adequate supervision to a resident in care. It was alleged that
client leaves the house at night and bangs on neighbors’ door and window.

During the visit LPA interviewed the Administrator, 3 staff and Educator. Interviews revealed that C1 has a history of AWOL. While living at this facility, C1 had a habit of leaving the facility and going to various neighbors' houses and knocking / banging on their doors (SIRs provided to LPA). Administrator and staff stated that they followed closely behind the client and tried to redirect the client. Staff was always present when the client attempted to AWOL. Interviewed Administrator and staff denied the allegation that staff not providing adequate supervision to the client in care, stating the facility schedules 2 staff during the day and 2 staff at night. Per Administrator interview due to C1's history of AWOL and increase in behaviors, Administrator met with Placement Agency and have discussed C1 relocation to a higher level of care facility. C1's relocation is currently pending. Interviewed C1 stated that the staff always follow them when they are leaving the facility. Interviews and documentation reviewed do not corroborate this allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted with Administrator and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2