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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603293
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:04:40 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
05/22/2023 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230522121818
FACILITY NAME:ORANGE GROVE RESIDENTIAL CAREFACILITY NUMBER:
198603293
ADMINISTRATOR:MYALUISA DOBSONFACILITY TYPE:
735
ADDRESS:1775 S. ORANGE GROVE AVETELEPHONE:
(323) 707-0053
CITY:LOS ANGELESSTATE: CAZIP CODE:
90019
CAPACITY:4CENSUS: 3DATE:
05/30/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Mya DobsonTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff won't allow authorized representative inside the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Mya Dobson and explained the reason for the visit.

The investigation consisted of: LPA conducted interviews with Administrator Mya Dobson, Staff 1-2, Client 2 (C2) and C1 by telephone. C3-4 were at their day program. LPA obtained copies of Staff and Client Rosters. LPA reviewed C1-4's file and collected copies of documents relevant to the investigation. LPA additionally attempted phone calls to Frank D Lanterman Regional Center Service Coordinator (SC) Tiffany Adams and C1 Family Member (C1 FM).


(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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-20230522121818
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: ORANGE GROVE RESIDENTIAL CARE
FACILITY NUMBER: 198603293
VISIT DATE: 05/30/2023
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff won't allow authorized representative inside the facility, it is alleged that facility staff will not allow C1 FM in the facility, staff have stated that C1 FM is rude to staff and is not welcome inside the facility. C1 FM is allegedly not allowed by facility staff to help C1 to pack and move C1's belongings to their new home and was informed by facility staff that they will pack C1's belongings. Interviews with Administrator Mya Dobson and S1-2 revealed that staff did not deny C1 FM to assist with packing and moving C1's belongings. They stated that C1 was asked previously to step out of the facility due to C1 FM behavior and being aggressive with facility staff and also kicking the facility front door which caused disruption in the facility for the other clients. Administrator stated that Frank D Lanterman SC Tiffany Adams was aware of the incident. Staff stated that C1 FM did not attempt to try to help C1 pack up their belongings or assist with moving C1 to their new facility. They stated that C1 FM did not get in contact with facility staff in regards to packing C1's belongings. Staff stated that they packed up, labeled and ensured that all of C1's belongings were properly packed and C1 was aware and did not have any concerns. Staff stated that C1 is an unconserved individual and was present when all their belongings were being packed and was provided with a copy of their Personal Property and Clothing Record. Staff stated that C1 did not have any concerns. LPA conducted interviews with 2 clients who both stated that they have never had any concerns with staff not allowing them to have any visitors or not allowing any authorized representatives inside of the facility to visit with them. Interview conducted with Frank D Lanterman Regional Center SC Tiffany Adams revealed that regional center did have any concerns regarding staff not allowing C1 to have an authorized representative inside of the facility. She stated that as C1 is unconserved the Regional Center is the client's authorized representative. She also stated that C1 FM was asked to leave the home in a previous occasions as their behavior was disrupting the operation of the facility as well as the other clients in placement. She stated that facility administrator has always been transparent and made proper reporting if it was ever required and she has no concerns regarding the facility.

Based on statements gathered from interviews conducted with staff, Regional Center staff, facility clients and LPA record review, there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Administrator Mya Dobson.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Alma Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2