306004436-10-6-2021-28-AS-FFIS-C8L3Q8-20211108172643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004436
Report Date: 10/06/2021
Date Signed: 10/06/2021 03:31:30 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
03/02/2020 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200302132740

FACILITY NAME:	STONYBROOK RESIDENTAL CARE II		FACILITY NUMBER:	306004436
ADMINISTRATOR:	CLIFFORD T VALMEO		FACILITY TYPE:	735
ADDRESS:	2301 PEPPERWOOD AVENUE		TELEPHONE:	(714) 240-7699
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90808
CAPACITY:	4	CENSUS: 2	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Staff Cesar Eguilos		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Staff left residents unsupervised in the facility.
Staff mismanaged resident’s medication.
Regional Center ratio requirements are not being met.

INVESTIGATION FINDINGS:

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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. Staff #3 (S3) and #4 (S4) were also not available for interview at the time of the visit.

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)

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Control Number 28-AS-20200302132740

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

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The investigation revealed the following; In regards to the allegation "Staff handled resident in a rough manner." it was alleged that on 2/22/20 Staff #3 (S3) body shoved C1 in the facility. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. S3 no longer works in the facility and was unavailable for interview. Review of documents collected do not show the incident occurring. Interview with C1's placement agency does show that the incident occurred. Based on LPA's 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 left residents unsupervised in the facility. " it was alleged that on 2/28/20 around 7:40 PM the residents were sleeping in their rooms and there was no staff member in the house. A 2 minute and 42 second video of C1 walking around the home at 7:46pm was provided that did not show staff inside the facility. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews show that Staff #4 (S4) was the staff member working the night of 2/28. According to staff, S4 was at the front of the facility for about 5-10 minutes and not away from the property. According to client interview, S4 was not inside the facility and gone for over 30 minutes. Investigation conducted by C1's placement agency show that only C1 and S4 were present during this alleged incident. The placement agency determined that S4 was present on property but not inside and due to conflicting statements, whether the time S4 was outside of the facility cannot be ascertained. Based on LPA's 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 mismanaged resident’s medication." it was alleged that on 2/27/2020 C1 asked for their morning meds, but were not given until 5 PM. (2) of (2) staff interviewed denied the allegation. (2) of (2) clients interviewed could not corroborate the allegation. Interviews show that C1 has a history of refusing medication and taking the medication when C1 chooses to. LPA was not provided more information as to whether client refused medication on this day and did not observe missed medication documentation for this date. Based on LPA's 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

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)

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Control Number 28-AS-20200302132740

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

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In regards to the allegation "Regional Center ratio requirements are not being met." it was alleged that per Regional Center regulations, there should be more than 1 staff present overnight and that was not being met. (2) of (2) staff interviewed denied the allegation. (1) of (2) clients interviewed did state that only one staff is available overnight. Interviews show that no client in care requires 1 on 1 supervision overnight that would make it necessary to have more than 1 staff present. Interviews with regional center confirmed that having 1 staff overnight for this home is not against regulation unless 1 or more clients in care required 1 on 1 supervision overnight. Based on LPA's 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)

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