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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004212
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:55:04 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, 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
08/05/2022 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220805114033
FACILITY NAME:MERCEDES DIAZ HOMES INC - STARWOODFACILITY NUMBER:
306004212
ADMINISTRATOR:CRYSTAL ALEGREFACILITY TYPE:
735
ADDRESS:16321 STARWOOD DRTELEPHONE:
(562) 947-8307
CITY:WHITTIERSTATE: CAZIP CODE:
90604
CAPACITY:6CENSUS: 6DATE:
12/05/2023
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Yanira RivasTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Resident(s) were slapped by staff while in care.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA) Angelica Rea conducted another visit to deliver the final results of the investigation. LPA met with Administrator, Yanira Rivas who assisted with today's visit.

Regarding the allegation that Resident(s) were slapped by staff while in care, the investigation consisted of interviews with Administrator, Staff #2 - Staff #4, Day Program Staff and Residents #1 - Resident # 3. The investigation revealed that on 8/4/22 Resident #1 and Resident #2 reported to Administrator that Staff #1 slapped them on the face. Residents interviewed corroborated the allegation. Residents interviewed were consistent in their statements. Staff interviewed did not witness the incident, however staff stated that resident(s) #1 and #2 reported to staff interviewed that they had been hit by staff #1. Administrator stated that staff #1 was immedicately removed from the schedule, was terminated, and did not return to work at the facility. Administrator LPA was unable to interview Staff #1 for the investigation, due to staff #1 no longer working at the facility. Administrator submitted a special incident report to Community Care Licensing as required. LPA reviewed Corrective Action Report dated 8/23/22 from Eastern Los Angeles Regional Center.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
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-20220805114033
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: MERCEDES DIAZ HOMES INC - STARWOOD
FACILITY NUMBER: 306004212
VISIT DATE: 12/05/2023
NARRATIVE
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Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 Division 6, Chapter 1.

An exit interview was conducted with Ms. Rivas. A copy of the report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220805114033
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: MERCEDES DIAZ HOMES INC - STARWOOD
FACILITY NUMBER: 306004212
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2023
Section Cited
CCR
80072(a)(3)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Administrator will provide an in staff training on Section 80072, Personal Rights and will send proof of training to LPA by POC due date.
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This requirement was not being met as evidenced by: investigation revealed that Resident #1 and Resident #2 were slapped by Staff #1. This poses a health 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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3