306003751-8-16-2023-28-AS-FFIS-CV5PHU-20230828112031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 08/14/2023
Date Signed: 08/16/2023 10:28:36 AM

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
10/21/2022 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221021160401

FACILITY NAME:	CRJ HOME		FACILITY NUMBER:	306003751
ADMINISTRATOR:	CRISTINA SANTOS		FACILITY TYPE:	735
ADDRESS:	15044 BARNWALL STREET		TELEPHONE:	(714) 521-5956
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	6	CENSUS: 4	DATE:	08/14/2023
		UNANNOUNCED	TIME BEGAN:	08:10 AM
MET WITH:	Staff Kim Salvador		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff had an inappropriate interaction with resident in care while in the shower

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced subsequent complaint investigation visit for the allegation above. LPA met with Staff Kim Salvador and the purpose of the visit was discussed.

Initial visit was conducted on 10/25/22 and consisted of the following: LPA conducted a tour physical plant. LPA collected documents from Client #1's (C1's) file as well as a staff and client roster. LPA interviewed Staff #1 (S1)

As of todays visit, LPA has also reviewed documents from C1's placement agency related to the alleged incident, interviewed staff #2-#4 (S2-S4) and attempted to interview Staff #5-#6 (S5-S6) but they were unavailable and no longer work in the facility. LPA also interviewed clients #1-#4 (C1-C4). LPA also interviewed C1's responsible party and placement agency. The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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 28-AS-20221021160401

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: CRJ HOME	FACILITY NUMBER: 306003751
	VISIT DATE: 08/14/2023

NARRATIVE

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In regards to the allegation "Staff had an inappropriate interaction with resident in care while in the shower" it was alleged that staff had inappropriately touched C1 while assisting them with their shower. (4) of (4) Staff interviewed denied the allegation. (4) of (4) Clients interviewed could not corroborate the allegation. Interview with C1 did not state staff having inappropriate interactions with them but that it was C2. File review conducted by LPA shows an incident report dated 10/15/22 stating that police arrived to the facility to investigate alleged sexual assault of C1 by C2. There are no notes or statements alleging staff of assaulting or inappropriately interacting with C1 on this report. C2 denied the allegation. There is also an incident report dated 10/12/22 stating S5 was suspended for leaving C1 unattended in the shower so that they could use the other restroom. This report states that C2 walked in and observed C1 changing and so they assisted C1 in changing. The report does not mention staff inappropriately touching C1. Interviews show that C1 went to their families home for a visit on 10/28/22 and did not return to the facility. During this home visit additional information was provided adding that S6 sexually abused C1. LPA reviewed documentation of C1's Placement Agency conducting an investigation on the facility. It shows an unsubstantiated findings into an allegation of S6 sexually abusing C1. Interview with C1's placement agencies staff does not show that C1 was sexually abused by staff of the facility. Interviews conducted with staff all deny that any staff inappropriately touched C1. Interviews with Clients does not show that staff inappropriately interacted with C1 in the facility. Based on interviews, file review, and observations conducted; 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 and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC9099 (FAS) - (06/04)

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