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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005542
Report Date: 07/31/2024
Date Signed: 07/31/2024 03:18:39 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
07/25/2024 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240725112440
FACILITY NAME:ELIZABETH HOMES - BERRY AVEFACILITY NUMBER:
306005542
ADMINISTRATOR:SANTOS, ELIZABETHFACILITY TYPE:
735
ADDRESS:6892 BERRY AVETELEPHONE:
(714) 995-3988
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY:6CENSUS: 4DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shirley KniazeffTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff handled client in a rough and aggressive manner
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above. LPA met with Assistant Administrator (AAD) Shirley Kniazeff and explained the purpose of the inspection.

Interviews were conducted with three facility staff and all four facility clients. Three of four clients interviewed were unable to confirm or deny allegation due to being non-verbal. One of four clients denied personally being handled in a rough or aggressive manner by staff and denied witnessing staff handling any other client in a rough or aggressive manner. During their interviews, three of three staff denied witnessing or having any knowledge of facility staff handling any client in a rough or aggressive manner. Three of three staff also denied personally handling any client in a rough or aggressive manner.

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

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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-20240725112440
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: ELIZABETH HOMES - BERRY AVE
FACILITY NUMBER: 306005542
VISIT DATE: 07/31/2024
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: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2