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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004295
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:13:15 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/18/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230418101613
FACILITY NAME:NELDYS ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004295
ADMINISTRATOR:JON NEIL CASTROFACILITY TYPE:
735
ADDRESS:11411 STANFORD AVENUETELEPHONE:
(714) 539-5151
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 5DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Facility Administrator - Jon CastroTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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2
3
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8
9
Facility falsify documents
Staff are speaking another language in client's presence
Staff yell at residents
Staff are engaging in public displays of affection in the presence of clients
INVESTIGATION FINDINGS:
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4
5
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7
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9
10
11
12
13
Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Jon Castro.

It was alleged that facility falsify documents. LPA De Perio conducted 4 client interviews who were unable to provide information regarding this allegation. 3 of the staff interviews provided direct admission by stating that the facility has a close friend who signs off CPR certifications without staff actually having to attend and complete the courses.

It was alleged that the staff are speaking another language in client's presence. A total of 7 interviews conducted with staff and clients, of which all 7 interviews corroborated with the allegation by providing direct admission of speaking in another language. During the visit conducted on 04/26/23, LPA De Perio observed staff speaking to each other in a different language around the clients
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
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 6
Control Number 22-AS-20230418101613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
VISIT DATE: 10/10/2023
NARRATIVE
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It was alleged that the staff yell at clients. A total of 4 interviews were conducted with clients who stated that staff 1 (S1) yells and “gets mad”. 1 client interview specified that S1 “yelled at me today before you got here”. 3 interviews were conducted with staff who also stated that S1 yells at the clients. 1 of the staff interviews were conducted with S1, who also provided direct admission of yelling at a client, and specified "I only did it once".

It was alleged that staff are engaging in public displays of affection in the presence of clients. A total of 4 interviews were conducted with clients who verified that staff 1 (S1) and staff 2 (S2) are “boyfriend and girlfriend”. 2 of the client interviews specified that S1 and S2 “kiss and hug”. 4 of the client interviews confirmed of seeing S1 and S2 kiss and hug. LPA De Perio conducted 3 interviews with staff of which 2 interviews corroborated with the allegation, and 1 interview stated that S1 and S2 no longer share the same shift due to hearing complaints regarding displays of affection.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, the preponderance of evidence standard has been met, therefore the allegations are SUBSTANTIATED.


An exit interview was conducted with AD Castro. A copy of this report was explained, and appeal rights were provided during the visit.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/18/2023 and conducted by Evaluator Celine DePerio
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230418101613

FACILITY NAME:NELDYS ADULT RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004295
ADMINISTRATOR:JON NEIL CASTROFACILITY TYPE:
735
ADDRESS:11411 STANFORD AVENUETELEPHONE:
(714) 539-5151
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 5DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Facility Administrator - Jon CastroTIME COMPLETED:
11:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not providing clients with outings
Staff threatened client with a rod
Clients are not receiving P&I Money
It was alleged that clients are transported in uninsured vehicle
It was alleged that staff are not qualified to provide care and supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
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12
13
Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted, and granted entry by facility administrator (AD) Jon Castro.

It was alleged that facility is not providing clients with outings. LPA De Perio conducted a total of 4 client interviews, of which all client interviews did not corroborate with the allegation by stating that the facility staff take them to outings such as the beach, restaurants and the park.

It was alleged that staff threatened client with a rod. A total of 4 interviews were conducted with clients, of which the 4 interviews did not provide information regarding this allegation and denied of being threated with, or witnessing another client being threatened. A total of 3 interviews were conducted with staff, of which 2 of the interviews did not corroborate with the allegation, and 1 interview corroborated with the allegation by stating that staff 1 (S1) heard staff 2 (S2) threatened client 1 (C1) with a rod.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 22-AS-20230418101613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
VISIT DATE: 10/10/2023
NARRATIVE
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3
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5
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8
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It was alleged that clients are not receiving P&I Money. A total of 4 interviews were conducted with clients, of which 4 of the interviews did not corroborate with the allegation by stating that they are receiving their P&I money. A total of 3 interviews were conducted with staff, of which 3 interviews stated that the facility is being audited monthly regarding the P&I money due to issues in the past. LPA also observed that the facility keeps an individual P&I money log per client and is up to date.


It was alleged that clients are transported in uninsured vehicle. A total of 4 interviews were conducted with clients, of which the 4 interviews were unable to provide information regarding this allegation. A total of 3 interviews were conducted with staff, of which 3 interviews did not corroborate with the allegation by stating the facility vehicle is insured. 1 of the staff interviews stated that the facility missed the deadline to renew the vehicle insurance in the past, however, is now up to date. LPA De Perio conducted record reviews and observed that the facility vehicle is insured.

It was alleged that staff are not qualified to provide care and supervision. A total of 4 interviews were conducted with clients, of which 4 of the interviews stated that staff provide adequate care and supervision, and expressed that there were no health and safety concerns regarding care. A total of 3 interviews were conducted with staff, of which all 3 interviews stated that staff are required to go through training prior to independently providing care and supervision to clients.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Castro and a copy of this report was provided and explained.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20230418101613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2023
Section Cited
HSC
1550(c)
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§1550 Licenses or administrator Certificates; suspension, revocation or denial of application; grounds
(c) Conduct which is inimical to the health...of..the...individual...receiving services from, the facility...
This requirement is not met as evidence by:
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2
3
4
5
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As a plan of correction (POC), licensee will provide training to all staff regarding the regulation cited, and will provide proof of training and understanding to LPA on or by 10/13/23.
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Based on the interviews conducted, staff provided direct admission of having documents signed off by another individual, and denied of having to attend mandatory trainings such as CPR training. This poses an immediate health and safety risk to clients in care.
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Type B
10/17/2023
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) ...Each client shall have personal rights which include, but are not limited...
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidence by:
1
2
3
4
5
6
7
As a plan of correction (POC), licensee will provide training to all staff regarding the regulation cited, and will provide proof of training and understanding to LPA on or by 10/17/23.
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9
10
11
12
13
14
Based on the interviews conducted, staff and clients provided direct admission of staff speaking in another language in the presence of the clients. During LPA's visit, LPA observed staff on duty speaking in another language. This poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20230418101613
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: NELDYS ADULT RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004295
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2023
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
80072 Personal Rights
(a) ...Each client shall have personal rights which include, but are not limited to...
(3) To be free from corporal or unusual punishment...humiliation, intimidation, ridicule...
This requirement is not met as evidence by:
1
2
3
4
5
6
7
As a plan of correction (POC), licensee will provide training to all staff regarding the regulation cited, and will provide proof of training and understanding to LPA on or by 10/17/23.
8
9
10
11
12
13
14
Based on the interviews conducted, staff and clients provided direct admission of staff yelling at a client.
This poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
Type B
10/17/2023
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
80072 Personal Rights
(a) ...Each client shall have personal rights which include, but are not limited...
(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidence by:
1
2
3
4
5
6
7
As a plan of correction (POC), licensee will provide training to all staff regarding the regulation cited, and will provide proof of training and understanding to LPA on or by 10/17/23.
8
9
10
11
12
13
14
Based on interviews conducted, staff and clients provided direct admission of staff 1 (S1) and staff 2 (S2) displaying public affection through kissing and hugging.
This poses a potential health and safety risk to clients in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Celine DePerio
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6