306001215-10-16-2024-22-AS-MSTC-DAJ5MV-20241029200520

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001215
Report Date: 10/16/2024
Date Signed: 10/16/2024 04:14:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
03/05/2024 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240305133436

FACILITY NAME:	ELIZABETH HOMES/SAN RICARDO		FACILITY NUMBER:	306001215
ADMINISTRATOR:	SANTOS, ELIZABETH		FACILITY TYPE:	735
ADDRESS:	6303 SAN RICARDO WAY		TELEPHONE:	(714) 995-1106
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY:	6	CENSUS: 3	DATE:	10/16/2024
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Shirley Kniazeff		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Staff are hitting a client causing bruises and marks to their face.
Staff denied medical attention to client while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to complete, close, and deliver findings on the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit. The complaint investigation consisted of interviews with facility staff, facility clients, a witness, and document review.

Regarding the allegation: Staff are hitting a client causing bruises and marks to their face.

7 of 7 individuals interviewed denied the complaint allegation and/or could not provide any information to corroborate the complaint allegation. During an interview with Client 1 (C1), the complaint allegation was denied. Three different staff members also denied the complaint allegation. Document review revealed C1 has challenging behaviors that are documented in C1’s Individualized Program Plan (IPP).
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

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 22-AS-20240305133436

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ELIZABETH HOMES/SAN RICARDO	FACILITY NUMBER: 306001215
	VISIT DATE: 10/16/2024

NARRATIVE

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Some of the challenging behaviors include disruptive social behavior, destructing of property, and emotional outburst. Review of C1’s IPP revealed C1 continues to engage in aggressive behavior towards staff such as hitting, pushing, or slapping. The emotional outburst occur at least once a week, and C1 will display physical aggression towards staff when C1 doesn't sleep well. Information discovered during a review of C1’s IPP was consistent with information gathered during interviews.

Regarding the allegation: Staff denied medical attention to client while in care.

7 of 7 individuals interviewed denied the complaint allegation and/or could not provide any information to corroborate the complaint allegation. During an interview with Witness 1 (W1) it was revealed W1 sees C1 all the time. W1 stated when they see C1, the client is always happy and has never told or reported anything. At the time of the interview, W1 said the last time they seen C1 was in January. During an interview with Staff 1 (S1), it was discovered facility staff do a daily body check on C1 and a body check before C1 leaves with family. S1 stated, C1 leaves with family for as long as 10-days at a time.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegations are deemed Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2024

LIC9099 (FAS) - (06/04)

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