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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000801
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:53:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220815134214
FACILITY NAME:CHAPMAN BOARD & CAREFACILITY NUMBER:
306000801
ADMINISTRATOR:BRYSON NAZARENOFACILITY TYPE:
735
ADDRESS:10811 CHAPMAN AVE.TELEPHONE:
(714) 638-8777
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:49CENSUS: 48DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Matthew NazarenoTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Unlawful eviction.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Administrator (AD) Matthew Nazareno and explained the reason for today’s inspection. The investigation into the allegation(s) of unlawful eviction revealed the following: During the course of the investigation, LPA inspected 10 resident rooms (including both beds in each room), interviewed AD, 6 residents, and 1 staff, and requested and reviewed copies of the resident roster, staff roster, drug test results, pest control records, recent eviction notices, and house rules.

When interviewed, AD stated that Resident #1 (R1) and Resident #2 (R2) are being evicted, AD served written 30-day eviction notices on these residents on 07/18/22 and 08/06/22 respectively, and that R1 and R2 signed the eviction notices. LPA reviewed copies of these eviction notices and confirmed that they were signed by R1 and R2.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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 7
Control Number 22-AS-20220815134214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CHAPMAN BOARD & CARE
FACILITY NUMBER: 306000801
VISIT DATE: 10/12/2022
NARRATIVE
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However, AD stated that that AD had not provided written notice to the representatives/responsible persons for R1 or R2 and had not provided Community Care Licensing Division (CCLD) with copies of the eviction notices. After LPA’s inspection on 08/19/22, LPA provided technical assistance to AD regarding eviction notices and AD properly re-served the eviction notices on R1 and R2. Interviews revealed that R1 and R1’s responsible person were threatened by AD that once the 30-day notice period was over, R1’s belongings would be removed from the facility to ensure that R1 leaves. When interviewed, AD could not recall what he had said to R1 and R1’s responsible person about the procedure for the eviction.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20220815134214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CHAPMAN BOARD & CARE
FACILITY NUMBER: 306000801
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2022
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) … personal rights which include…: (3) To be free from … intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature …. This requirement was not met as evidenced by:
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Licensee stated they will reread Section 80072 Personal Rights and submit a statement of understanding to LPA by POC due date.
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Based on interviews, the licensee did not ensure R1’s personal rights were protected when facility staff threatened to remove R1’s belongings from the facility to facilitate R1’s eviction, which poses an immediate personal rights and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/15/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220815134214

FACILITY NAME:CHAPMAN BOARD & CAREFACILITY NUMBER:
306000801
ADMINISTRATOR:BRYSON NAZARENOFACILITY TYPE:
735
ADDRESS:10811 CHAPMAN AVE.TELEPHONE:
(714) 638-8777
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:49CENSUS: 48DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Matthew NazarenoTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Facility is infested with bed bugs
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation(s). LPA met with Administrator (AD) Matthew Nazareno and explained the reason for today’s inspection. The investigation into the allegation(s) that facility is infested with bed bugs revealed the following: During the course of the investigation, LPA inspected 10 resident rooms (including both beds in each room), interviewed AD, 6 residents, and 1 staff, and requested and reviewed copies of the resident roster, staff roster, drug test results, pest control records, recent eviction notices, and house rules.
1 staff interviewed stated that the facility has had issues with bed bugs in the past but takes ongoing measures to address them. When interviewed, AD stated that the facility takes ongoing measures to address bed bugs at the facility, including that a pest control company checks and sprays regularly, the facility has its own supply of bed bug pesticide to use as needed, linens are changed at least every week and more often if needed, and mattresses are covered in plastic coverings under the bed sheets as a preventative measure that has been successful.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 22-AS-20220815134214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CHAPMAN BOARD & CARE
FACILITY NUMBER: 306000801
VISIT DATE: 10/12/2022
NARRATIVE
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Per AD, on 08/11/22, the pest control company conducted an inspection and found no bed bugs at the facility. LPA reviewed pest control records corroborating AD’s statements that the pest control company checks and sprays regularly and that the pest control company conducted an inspection on 08/11/22 and found no bed bugs at the facility. 2 out of 6 residents interviewed stated that despite the facility’s efforts, there are still bed bugs. However, 4 out of 6 residents interviewed corroborated that the facility’s measures have been successful and there are currently no bed bugs at the facility. LPA inspected 10 resident rooms (including both beds in each room) and observed no bed bugs. While the facility may still have some bed bugs, the facility’s ongoing pest control measures appear to have been successful in preventing an infestation.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 7