306004248-5-11-2023-28-AS-TVAO-CSRSFP-20230613135041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004248
Report Date: 05/11/2023
Date Signed: 05/11/2023 02:01:36 PM

Unsubstantiated

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
05/03/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230503162215

FACILITY NAME:	ELWYN NC - BARNWALL		FACILITY NUMBER:	306004248
ADMINISTRATOR:	TERESA OPORTO		FACILITY TYPE:	735
ADDRESS:	15319 BARNWALL ST		TELEPHONE:	(714) 670-8600
CITY:	LA MIRADA	STATE: CA	ZIP CODE:	90638
CAPACITY:	4	CENSUS: 3	DATE:	05/11/2023
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Brittany Ruiz, Licensed Psychiatric Technician		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Facility staff are restraining client with a belt.
Staff is smoking marijuana while clients are present.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Staff, Brittany Ruiz. The purpose for the visit was explained. The administrator, Eddie Velarde, arrived shortly thereafter.

LPA obtained a copy of the staff roster, client roster, and physician's order for Clients #1 - #3. Interviews were conducted with the administrator and 7 Staff. LPA attempted to interview the 3 Clients.

The investigation revealed the following:
Allegation - Facility staff are restraining client with a belt. It is alleged that staff are using the gait belt to restrain client into a wheelchair and from walking around. LPA interviewed the Administrator and 7 Staff today. The Administrator is not aware of this happening at the facility and restraint is not allowed. Per Staff, they denied restraining clients with a gait belt.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
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)

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Control Number 28-AS-20230503162215

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: ELWYN NC - BARNWALL	FACILITY NUMBER: 306004248
	VISIT DATE: 05/11/2023

NARRATIVE

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They stated that with 2 of the 3 clients, they would sometimes use a gait belt for postural support and to safely assist them while walking. They do not use it to strap a client onto a wheelchair as a way to prevent them from getting up. Staff stated that they encourage clients to move around freely with their kneepads and/or elbow pads for those who need it for protection. LPA obtained and reviewed the Physician's Order form for 3 clients. The form consist of the physician's signature and is valid for 1 year from date of signature. During the visit, LPA observed one client wheelchair bound and another placed in a wheelchair to transport to the facility vehicle. LPA did not observe any discrepancies with the usage of postural supports for the clients in care. LPA attempted to interview the 3 Clients at the facility but did not obtain any response.

Allegation - Staff is smoking marijuana while clients are present. Per the administrator, he is not aware of any staff smoking marijuana at the facility. He stated smoking is not permitted inside the facility and there has not been any reports from staff indicating the use of marijuana. 6 out of 7 Staff interviewed have not observed any staff smoking during their shift. One stated that a staff would take a smoking break outside in the car but never inside the house. There is no smell of marijuana upon returning from break. Based on information gathered, there is insufficient evidence to prove this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
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)

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