<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004436
Report Date: 10/06/2021
Date Signed: 10/06/2021 03:35:27 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/27/2020 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200227161540
FACILITY NAME:STONYBROOK RESIDENTAL CARE IIFACILITY NUMBER:
306004436
ADMINISTRATOR:CLIFFORD T VALMEOFACILITY TYPE:
735
ADDRESS:2301 PEPPERWOOD AVENUETELEPHONE:
(714) 240-7699
CITY:LONG BEACHSTATE: CAZIP CODE:
90808
CAPACITY:4CENSUS: 2DATE:
10/06/2021
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Staff Cesar EguilosTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client's right were violated by staff
Facility did not meet client's needs
Facility is not kept clean, orderly and sanitary
Lack of supervision amongst clients
Staff failed to safeguard clients' personal property
Facility does not provide clients a working phone in case of an emergency
Facility has pests
Staff member falsified client's records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent unannounced complaint visit regarding the above allegations. LPA met with staff Cesar Eguilos and explained the reason for the visit.

The initial visit was conducted on 3/6/20 where LPA Day interviewed Administrator (S1), reviewed the file of Client #1 (C1), including medication log. LPA toured the facility.

At the time of this visit, LPA Villalobos interviewed Client #3-#4 (C3-C4) and Staff #2. LPA also interviewed C1's placement agency and reviewed documentation regarding C1. LPA Villalobos also toured the physical plant. Client #1 and Client #2 (C2) were not available for interviews as they no longer reside in the facility.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
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 4
Control Number 28-AS-20200227161540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: STONYBROOK RESIDENTAL CARE II
FACILITY NUMBER: 306004436
VISIT DATE: 10/06/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following; In regards to the allegation, "Client's right were violated by staff" it was alleged that C1 was not allowed to go into the community alone because S1 stated C1 hadn’t earned it. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews show that C1 was allowed to go out into the community as part of C1's community access plan. Interviews with C1's placement agency confirmed this as well. Based on LPA review of documents and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation, "Facility did not meet client's needs" it was alleged that C1 was not allowed be an adult and make adult decisions while growing as a person. Details provided state that C1 was not allowed to go to church, school, see friends; unless directly supervised by the household. (2) of (2) staff denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Review of documentation shows that C1 had a community access plan and was able to access the community. Interviews state that C1 was able to and did go out into the community without staff present and would also not sign out as requested. Based on LPA review of documents and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


In regards to the allegation, "Facility is not kept clean, orderly and sanitary" it was alleged that C2 urinates on the toilets that are often not cleaned until morning and that C2 covers the floors with food and is not cleaned. (2) of (2) staff denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. LPA Villalobos conducted a health and safety check on 2/21/20 and 10/6/21. LPA observed the facility to be in clean and good repair. Based on LPA observations and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

Continued on LIC 9099-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20200227161540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: STONYBROOK RESIDENTAL CARE II
FACILITY NUMBER: 306004436
VISIT DATE: 10/06/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation, "Lack of supervision amongst clients" it was alleged that C2 stands at the foot of peoples' beds in the dark watching them sleep and threatening people within the house and outside while staff are often either playing video games or sleeping. (2) of (2) staff interviewed denied the allegations. (2) of (2) clients interviewed could not corroborate the allegation. LPA was unable to get more details on the allegation and interviews did not show there being an issue with staff supervision. Based on LPA review of documents and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation, "Staff failed to safeguard clients' personal property" it was alleged that C2 has stolen other client’s property and has been allowed to keep it until C1 makes him give it back. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews show that C1 would leave their belongings around the house and C2 would pick things up randomly. This would upset C1 when some of the things C2 picked up belonged to C1. Interviews did not show that C2 was stealing other clients property or was picking up things with bad intent. Details of exact items being taken by C2 were not provided to LPA; therefore, based on LPA Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation, "Facility does not provide clients a working phone in case of an emergency" it was alleged that Clients are unable to make phone calls in emergency situations as the facility does not have a landline. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews state that clients have their own cellphones as well as there being a landline available for client use anytime. LPA Villalobos observed a working landline at the time of visit. Based on LPA's observations and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Continued on LIC 9099-C
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20200227161540
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: STONYBROOK RESIDENTAL CARE II
FACILITY NUMBER: 306004436
VISIT DATE: 10/06/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
In regards to the allegation, "Facility has pests" it was alleged that the facility had a termite issue in 2019 that affected C1's room for over a month. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews show that the facility has ongoing treatment done regularly around the property to keep it free of pests year long. The company that provides the services are does treatment inside the home where it would be necessary. LPA reviewed documentation of treatments done in the facility for the 2019 year. LPA was unable to get more information as to how C1's room was affected by the pest treatment done in the facility. Based on LPA review of documents and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED


In regards to the allegation, "Staff member falsified client's records" it was alleged that about a year and a half ago, facility staff would falsify data and reports making false accusations about C1. (2) of (2) staff denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. No further details were provided to LPA Villalobos. Review of C1's file does not show signs of falsified information. Interview with C1's placement agency did not provide evidence that facility staff was falsifying information. Based on LPA review of documents and Interviews conducted there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with staff Cesar Eguilos and a copy of this report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Jose Villalobos
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4