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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 02/02/2024
Date Signed: 02/02/2024 11:23:25 AM

Substantiated


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
01/29/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240129161527
FACILITY NAME:CRJ HOMEFACILITY NUMBER:
306003751
ADMINISTRATOR:CRISTINA SANTOSFACILITY TYPE:
735
ADDRESS:15044 BARNWALL STREETTELEPHONE:
(714) 521-5956
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 4DATE:
02/02/2024
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Loida Samonte, House SupervisorTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Facility has roach infestation.
Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit to investigate the above allegations. The purpose of the visit was explained to DSP staff Kim Holden Salvador. Administrator was explained the purpose and interviewed telephonically. House Supervisor Loida Samonte arrived later.

The investigation consisted of the following: A physical plant tour of the interior and exterior of the facility was completed. Staff (S1-S5) were interviewed. Residents were not interviewed because they were at the day program. Pest Control invoices, staff schedule, and resident roster documents were obtained. Pictures were obtained depicting disrepair. Additionally, the Eastern Los Angeles Regional Center Corrective Action Plan (CAP) Report and CAP Notice of Completion letter.

***Report continues next page.****
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
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 28-AS-20240129161527
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: 02/02/2024
NARRATIVE
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Allegation: Facility has roach infestation. According to information obtained the facility had a cockroach infestation in the kitchen and bathroom in early June 2023. The facility alleged that the cockroach problem was first discovered on June 4, 2023. A resident of the facility reported the cockroach infestation to the Eastern Los Angeles Regional Center (ELARC) on June 6, 2023. The facility submitted an incident report to ELARC and CCL until June 7, 2023. Administrator did not provide verbal notification to ELARC within 24 hours of discovering the cockroach infestation, and did not submit an incident report to the Regional Center within 48 hours per incident report guidelines. Based on staff interviews, the facility began to have cockroaches in March 2023 after the kitchen sink was repaired. They believe that when the plumbing was being repaired the cockroaches came in from the outside and it became a cockroach infestation. According to staff interviews, the facility had pest control services in place prior to the infestation. They notified the pest control company and the solution was to tent the facility. The facility was tented until June 25-27 after receiving Regional Center and CCL approval to temporarily relocate the residents to a hotel. The Regional Center issued a Corrective Action Plan (CAP) on November 15, 2023. Per Title 22 regulation, 80072 (a)(2) residents shall be "accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs". There is sufficient evidence to corroborate the allegation.

Allegation: Facility is in disrepair. It was reported to Community Care Licensing that on November 16, 2023 mold and mildew was observed in one of the facility bathrooms. Mildew was observed on shower tile, shower mat, and shower curtains. The facility had discarded debris in the backyard and the interior physical plant appeared to be disorderly and not cleaned regularly. A total of four (4) photographs were obtained showing that the bathroom was not cleaned regularly, and the upkeep and cleanliness of the facility is not satisfactory according to Title 22 regulation. Staff interviews revealed that both facility bathrooms were not maintained and cleaned as required. Staff acknowledged the bathroom was not cleaned regularly, and as a result mildew and mold grew throughout the bathroom. Staff stated that the bathrooms were old and it was hard to clean the tiles. This poses and health and safety risk to persons in care. The Regional Center conducted an unannounced visit on November 16, 2023, and made the above observations. This resulted in a substantial inadequacy with a Corrective Action Plan (CAP) report. A copy of the report was obtained. A sanction was placed on the facility by the Regional Center, and the sanction was lifted on January 26, 2024 because the facility completed the corrective action plan requests. During today's visit, room #2's floor (underneath bed) appeared to have not been swept in a while.

Based on interviews conducted and evidence obtained, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22. See LIC 9099D. An exit interview was conducted with House Supervisor Loida Samonte. A copy of the report and appeal rights were issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240129161527
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2024
Section Cited
CCR
80072(a)(2)
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Personal Rights. (a)...... (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement was not met evidenced by:
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Administrator shall submit in writing how the deficiency was corrected, and proof of staff training in addressing Title 22 Personal Rights regulation.
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The facility began to have a cockroach infestation in March 2023 after plumbing issue caused cockroach infestation into the home. The facility had pest control in place, but tented the facility until June 25, 2023; which posed a potential health, safety or personal rights risk to persons in care.
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Type B
02/09/2024
Section Cited
CCR
80087(a)
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Buildings and Grounds.The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement was not met evidenced by:
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Administrator shall submit:
1. Picture proof that a curtain rod has been placed in the smaller bathroom, and the larger bathroom tiles near the window have been deep cleaned.
2. Written statement of how the deficiency was corrected.
3. Proof of staff training pertaining to 80087
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Based on photographs obtained and interviews conducted, evidence shows that the facility bathrooms had mold and mildew, and the interior & exterior of the facility had discarded debris and was not orderly, which poses a potential health, safety or personal rights risk to persons 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3