198603362-8-20-2024-11-AS-JHAD-D96TGV-20240916144346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603362
Report Date: 08/20/2024
Date Signed: 08/20/2024 02:47:13 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/14/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20240814121921

FACILITY NAME:	DUNGARVIN CALIFORNIA - SIGNAL HILL		FACILITY NUMBER:	198603362
ADMINISTRATOR:	MARTIN, ALLISON		FACILITY TYPE:	775
ADDRESS:	695 EAST 27TH STREET		TELEPHONE:	(510) 727-9448
CITY:	SIGNAL HILL	STATE: CA	ZIP CODE:	90755
CAPACITY:	30	CENSUS: 36	DATE:	08/20/2024
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Director Juan Zepeda		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff hit a client.
Staff handled client in a rough manner while in care.
Staff speaks inappropriately to clients.
Staff speaks inappropriately to other staff in the presence of clients

INVESTIGATION FINDINGS:

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On 08/20/24 at 9:15 a.m., Licensing Program Analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Area Director (AD) Juan Zepeda as the purpose of today’s visit was explained.

The investigation consisted of the following: On 08/20/24 LPA obtained a copy of the staff and client rosters, LPA obtained documents pertaining to the complaint for Clients #1-2 (C1-C2), and for Staff #1 (S1). On 08/20/24 between 11am- 12:30 pm LPA conducted interviews with C1, C3, C4 and C5, between 12:30pm-1:30pm LPA conducted interviews with AD and staff #1-4 (S1-S4), at 2:29pm LPA conducted interview with responsible party for C2.

The investigation revealed the following:
Allegation: Staff hit client while in care.

It is being alleged that facility staff smacked client in the forehead. On 08/20/24 between 11am- 12:30 pm

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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 3

Control Number 11-AS-20240814121921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: DUNGARVIN CALIFORNIA - SIGNAL HILL	FACILITY NUMBER: 198603362
	VISIT DATE: 08/20/2024

NARRATIVE

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LPA conducted interviews with C1, C3, C4 and C5 regarding the allegation above, 4 of 4 clients interviewed denied the allegation above. On 08/20/24 at 12:30pm LPA interviewed AD regarding the allegation above, AD denied the allegation above and reported this behavior has not been observed or reported. On 08/20/24 between 12:30pm-1:30pm LPA interviewed S1-S4 denied the allegation above and stated such conduct would be reported to a supervisor. At 2:29pm LPA conducted interview with responsible party for C2, responsible party reported having no concerns regarding the C2 while at programming.

Allegation: Staff handled client in a rough manner while in care

It is being alleged that facility staff roughly pushed client into the day program van. On 08/20/24 between 11am- 12:30 pm LPA conducted interviews with C1, C3, C4 and C5 regarding the allegation above, 4 of 4 regarding the allegation above, 5 of 5 clients interviewed denied the allegation above. On 08/20/24 at 12:30 pm LPA interviewed AD regarding the allegation above, AD denied the allegation above and stated this behavior goes against day program policies. On 08/20/24 between 12:30pm-1:30pm LPA interviewed S1-S4 denied the allegation above and stated such conduct would be reported to a supervisor. At 2:29pm LPA conducted interview with responsible party for C2, responsible party reported having no concerns regarding the C2 while at programming.

Allegation: Staff speaks inappropriately to clients

It is being alleged that facility staff yells at clients while in care. On 08/20/24 between 11am- 12:30 pm LPA conducted interviews with C1, C3, C4 and C5 regarding the allegation above, 4 of 4 clients interviewed denied the allegation above. On 08/20/24 at 12:30 pm LPA interviewed AD regarding the allegation above, AD denied the allegation above and stated that this behavior goes against day program policies. On 08/20/24 between 12:30pm-1:30pm LPA interviewed S1-S4 denied the allegation above and stated such conduct would be reported to a supervisor. At 2:29pm LPA conducted interview with responsible party for C2, responsible party reported having no concerns regarding the C2 while at programming.

Allegation: Staff speaks inappropriately to other staff in the presence of clients

It is being alleged that facility staff handles situations inappropriately by yelling at other staff in the presence of clients. On 08/20/24 between 11am- 12:30 pm LPA conducted interviews with C1, C3, C4 and C5 regarding the allegation above, 4 of 4 clients interviewed denied the allegation above. On 08/20/24 at

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240814121921

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: DUNGARVIN CALIFORNIA - SIGNAL HILL	FACILITY NUMBER: 198603362
	VISIT DATE: 08/20/2024

NARRATIVE

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12:30 pm LPA interviewed AD regarding the allegation above, AD denied the allegation above and stated that this behavior goes against day program policies. On 08/20/24 between 12:30pm-1:30pm LPA interviewed S1-S4 denied the allegation above and stated such conduct would be reported to a supervisor. At 2:29pm LPA conducted interview with responsible party for C2, responsible party reported having no concerns regarding the C2 while at programming.

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 Area Director Juan Zepeda, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC9099 (FAS) - (06/04)

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