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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005938
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:46:28 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
10/11/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221011141708
FACILITY NAME:VIOLA HOMES ESTATEFACILITY NUMBER:
306005938
ADMINISTRATOR:DANIELA TILLESFACILITY TYPE:
735
ADDRESS:810 W. CIRCLE DRIVETELEPHONE:
(714) 867-7070
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:4CENSUS: 1DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Erika PenaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff yells at resident.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with staff Erika Pena and explained the reason for today’s inspection. Administrator (AD) Gazel Montes appeared via telephone.

The investigation into the allegation that Staff yells at resident revealed the following: During the course of the investigation, LPA interviewed AD, 1 staff, and 2 residents, and requested and reviewed copies of the resident roster, staff roster, resident files, and medication records.

When interviewed, one resident stated they had been yelled at four times by staff and another resident had witnessed one incident of staff yelling at a resident. Staff interviewed admitted to yelling at a resident after the resident yelled at them and slammed a door in their face and stated that the next day they talked it out and resolved their conflict.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
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 5
Control Number 22-AS-20221011141708
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: VIOLA HOMES ESTATE
FACILITY NUMBER: 306005938
VISIT DATE: 12/22/2022
NARRATIVE
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During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20221011141708
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: VIOLA HOMES ESTATE
FACILITY NUMBER: 306005938
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/23/2022
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) … include…: (3) To be free from … humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... This requirement was not met as evidenced by:
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Licensee stated they will train all staff on proper interactions with clients and submit proof to LPA by POC due date.
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Based on interviews, the licensee did not ensure staff were not yelling at residents, which poses an immediate personal rights and safety risk to residents in care.
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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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/11/2022 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20221011141708

FACILITY NAME:VIOLA HOMES ESTATEFACILITY NUMBER:
306005938
ADMINISTRATOR:DANIELA TILLESFACILITY TYPE:
735
ADDRESS:810 W. CIRCLE DRIVETELEPHONE:
(714) 867-7070
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:4CENSUS: 1DATE:
12/22/2022
UNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Erika PenaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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9
Staff do not distribute resident's medication as prescribed.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with staff Erika Pena and explained the reason for today’s inspection. Administrator (AD) Gazel Montes appeared via telephone.

The investigation into the allegation that Staff do not distribute resident's medication as prescribed revealed the following: During the course of the investigation, LPA interviewed AD, 1 staff, and 2 residents, and requested and reviewed copies of the resident roster, staff roster, resident files, and medication records.

When interviewed, Resident #1 (R1) stated that they did not receive a certain medication during the weekend of 10/08/22. One staff interviewed stated that the facility may have run out of this medication during that weekend, as they worked on 10/07/22 and there were 2 or 3 pills left by the end of the day. The staff also clarified that this is an as-needed medication with a maximum of 2 pills per day.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20221011141708
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: VIOLA HOMES ESTATE
FACILITY NUMBER: 306005938
VISIT DATE: 12/22/2022
NARRATIVE
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LPA reviewed R1’s medication records for October 2022 which show that R1 did not receive this medication for AM on 10/08/22, AM and PM on 10/09/22, AM and PM on 10/10/22, or AM on 10/11/22. LPA received conflicting information from facility staff and AD as to whether the medication records show R1 did not receive the medication because they did not ask for it or because the facility ran out of it. LPA reviewed pharmacy records which show 60 pills (a 30-day supply) of the medication were delivered to the facility on 09/01/22 and again on 10/11/22. However, R1’s medication records document that 57 pills were dispensed between these deliveries. The information received is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department 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 and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5