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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423843
Report Date: 09/23/2021
Date Signed: 09/23/2021 10:13:21 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2020 and conducted by Evaluator Natalie Gayoso
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201029114513
FACILITY NAME:FORTUNE CARE CENTERFACILITY NUMBER:
366423843
ADMINISTRATOR:LAYGO, ARCELIAFACILITY TYPE:
735
ADDRESS:22328 BROKEN LANCE RDTELEPHONE:
(760) 247-7925
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:6CENSUS: 4DATE:
09/23/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Arcelia LaygoTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit residents
Staff are verbally abusive to residents
Staff falsify training certifications
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Natalie Gayoso conducted an in-office meeting to deliver findings for the above allegations. LPA identified herself and discussed the purpose of today's meeting with Administrator, Arcelia Laygo.

The investigation consisted of interviews with staff, clients, and pertinent parties. The first allegation indicates staff hit residents. Interviews with clients stated they have never been hit by Staff 2 (S2) and Staff 3 (S3). Clients stated S2 and S3 treat them well. Interviews with staff indicated they have never witnessed S2 nor S3 hit any of the clients.

The second allegation indicates staff are verbally abusive to clients. Interviews with clients stated S2 and S3 have never been verbally abusive to them. Clients stated staff including S2 and S3 are nice. Interviews with staff stated S2 and S3 have never been verbally abusive to the clients in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
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 18-AS-20201029114513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: FORTUNE CARE CENTER
FACILITY NUMBER: 366423843
VISIT DATE: 09/23/2021
NARRATIVE
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The third allegation indicates staff falsify training certifications. Interviews with staff indicated that it is impossible to falsify training certificates since training is done by the facility’s Behaviorist and Inland Regional Center (IRC). LPA spoke with Behaviorist who stated training is provided monthly and as needed to the facility for the past 8 to 9 years. Trainings are done in person while social distancing or via Zoom (at times). A sign in sheet is taken to each training for participants to sign in and at the end of each training participants are required to take a test which they must print and sign their name. All tests are graded at another location and certificates are later mailed out. Individuals do not have access to cheating on tests nor falsifying certificates. Interview with IRC Senior Training Specialist stated all in person training is currently no longer being provided due to COVID. IRC was able to verify that employees of the facility are registered to take training classes online on the Learning Management System.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was provided to the Administrator.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Gayoso
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2