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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005189
Report Date: 06/06/2024
Date Signed: 06/06/2024 04:13:29 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, 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
05/30/2024 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240530153511
FACILITY NAME:EJ HOMESFACILITY NUMBER:
306005189
ADMINISTRATOR:CRUZ, PLACIDA DELAFACILITY TYPE:
735
ADDRESS:1231 WEST ARLINGTON AVETELEPHONE:
(714) 244-0656
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY:6CENSUS: 4DATE:
06/06/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jane Villacorta
Emmanuel Villacorta		TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
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5
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7
8
9
Facility staff yelled at client
INVESTIGATION FINDINGS:
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2
3
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5
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7
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9
10
11
12
13
An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Staff Jane Villacorta and Emmanuel Villacorta and explained the purpose of the inspection.

Interviews were conducted with two facility staff and all four facility clients. Three of four clients interviewed denied staff yell at them or other clients. One out of four clients confirmed staff yelled at them during one isolated incident, in which yelling consisted of Staff 1 (S1) raising their voice. During their interview, S1 denied yelling or raising their voice at client. S1 also denied having knowledge of other facility staff yelling at any client. Staff 2 (S2) was also interviewed and denied personally yelling at a client or witnessing S1 yelling at any client

Due to conflicting information received during interviews conducted, LPA is unable to determine if staff yelled at a client. (Cont. LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
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 2
Control Number 22-AS-20240530153511
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: EJ HOMES
FACILITY NUMBER: 306005189
VISIT DATE: 06/06/2024
NARRATIVE
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Although the above 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 at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2