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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306003751
Report Date: 05/11/2023
Date Signed: 05/11/2023 12:12:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/27/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220427171703
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: 3DATE:
05/11/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kim Salvador/S-6TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Client's funds are being mismanaged while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegation. LPA met with Kim Salvador and discussed the purpose of today's visit.

The initial investigation visit was conducted on 05/04/22. During today's visit, LPA interviewed Staff #1, Staff #2, Staff #5 (S-1, S-2 and S-5). LPA was unable to interview Staff #3 nor Staff #4 (S-3 and S-4) as they were not present during the time of this visit. LPA interviewed Client #1 and Client #2 (C-1 and C-2). LPA was unable to interview Client #3 through Client #5 (C-3 to C-5) as they were not home at the time of this visit. LPA also reviewed C-3's file and obtained relevant documentation.

During today's visit, LPA interviewed S-3, S-4 and S-6. LPA was unable to interview C-3 and C-4 as they no longer reside at this facility. LPA was not able to interview C-5 as C-5 was not home during this visit. LPA also obtained additional revelant documentation from C-3's file.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
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-20220427171703
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CRJ HOME
FACILITY NUMBER: 306003751
VISIT DATE: 05/11/2023
NARRATIVE
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Allegation: Client's funds are being mismanaged while in care. Staff interviews revealed that S-3 was cashing C-3’s checks through S-3’s bank account (per C-3’s request and to prevent C-3 from paying check cashing fees). Staff interviews revealed that the money from C-3’s cashed checks were documented on C-3's Personal & Incidental money log and safeguarded at this facility by staff. S-3 was unaware that S-3 was unable to cash C-3’s checks through S-3’s bank account. Staff interviews corroborates this allegation.

Based on LPA’s observations, interviews and records review, the preponderance of evidence standard has been met; therefore, the allegation noted above is found to be SUBSTANTIATED.



Deficiency was observed and cited per California Code of Regulation Title 22 Division 6. Refer to LIC9099D.

Exit interview held, copy of report and Appeal Rights provided to Kim Salvador.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220427171703
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CRJ HOME
FACILITY NUMBER: 306003751
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2023
Section Cited
CCR
80026(e)
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Safeguards for Cash Resources, Personal Property, and Valuables of Residents. (e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash.
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Administrator to conduct in-service for staff pertaining to P&I.

CORRECTED. LPA obtained a copy of the P&I in-service training conducted 05/02/22.
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This standard is not met as evidence by:

S-3 was cashing C-3’s checks through S-3’s bank account.
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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3