306005943-10-6-2021-22-AS-SSAS-C9CVHU-20211203152743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005943
Report Date: 10/06/2021
Date Signed: 10/06/2021 05:16:38 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
06/01/2021 and conducted by Evaluator Michelle Reed

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210601090207

FACILITY NAME:	MANDEL HOUSE		FACILITY NUMBER:	306005943
ADMINISTRATOR:	MCDONALD, LISA		FACILITY TYPE:	735
ADDRESS:	2220 CONCORD STREET		TELEPHONE:	(818) 782-2211
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	6	CENSUS: 3	DATE:	10/06/2021
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Administrator Yvette Doran		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Client #1 was observed to have unusual bruising on his upper body, back, stomach and face.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Michelle Reed made an unannounced visit to the facility for the purpose of presenting the findings of the complaint investigation. Upon arrival, LPA met with Administrator Yvette Doran. The complaint was investigated by the Department and consisted of interviews with the facility staff, Chief Program Officer Kimberly Lee, and witnesses as well as documentation. The following was determined:

Client #1 (C1) was admitted into Mandel House in December of 2019. In April of 2021 there was a change of ownership. C1 left the facility and then returned on 5/3/21. Records reviewed disclosed that C1 has a history of physical aggression and elopement. On 5/22/21, C1 left with his responsible party in the morning and returned a few hours later. C1 was observed to be agitated when he returned as he did not get to have lunch. S1 attempted to speak with C1 to calm him down. C1 began cursing at S1 and threw punches, spit, kicked and bit S1. S1 had to hold C1’s arms to stop the attack. C1 then headbutted S1 and they both fell to the floor. C1 obtained a cut on his forehead and S1 was bleeding by the mouth. S1 had to hold C1 down on the floor so that C1 would not punch or bite him again.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
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 22-AS-20210601090207

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: MANDEL HOUSE	FACILITY NUMBER: 306005943
	VISIT DATE: 10/06/2021

NARRATIVE

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C1 was the aggressor. S1 had to protect himself and to gain control of the situation when verbal communication failed to stop C1’s aggression during the altercation. S1 one was the only staff present at the time of the incident. C1 sustained bruises on his body and a cut on his forehead. S1 sustained human bites and abrasions to his left forearm, left middle finger and right upper arm. After the altercation, C1 continued to exhibit aggression by punching a hole in his bedroom wall. S1 immediately called another co-worker to come to the facility to help diffuse the situation.

Based upon Interviews and information obtained during the investigation the allegation is unsubstantiated, meaning that although the allegation of a personal rights violation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There is no evidence that S1 intentionally harmed C1.

An exit interview was conducted, and a copy of this report was provided to Yvette Doran.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Michelle Reed
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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