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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601852
Report Date: 04/12/2022
Date Signed: 04/12/2022 04:09:09 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, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/11/2022 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20220411133330
FACILITY NAME:MARROQUIN FACILITYFACILITY NUMBER:
198601852
ADMINISTRATOR:YOSMAN MARROQUINFACILITY TYPE:
735
ADDRESS:4025 S NORMANDIE AVETELEPHONE:
(213) 509-4397
CITY:LOS ANGELESSTATE: CAZIP CODE:
90037
CAPACITY:6CENSUS: 4DATE:
04/12/2022
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Yosman Marroquin-LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not provide adequate food service for the client
Client is not provided comfortable accommodations while in care
Uncleared adult is providing care and supervision
INVESTIGATION FINDINGS:
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On 4/12/2022, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint visit at this facility. LPA spoke with Licensee Yosman Marroquin via telephone prior to entering the facility to conduct risk assessment and was informed that facility has no COVID-19 cases nor do any of the clients have symptoms. LPA arrived at facility and explained the purposed of the visit is to investigate the allegations listed above.

The investigation consisted of the following: On 4/12/2022 LPA conducted a tour of facility grounds and reviewed records for staff and residents. LPA conducted interviews with (5) staff members (S1-S5), and (4) clients (C1-R4). LPA Cifuentes requested and received the following documents: Staff roster, needs and services plan for C1 and other documentation relevant to the investigation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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 3
Control Number 11-AS-20220411133330
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: MARROQUIN FACILITY
FACILITY NUMBER: 198601852
VISIT DATE: 04/12/2022
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff do not provide adequate food service for the clients

It is alleged that facility is not providing food to the clients. LPA toured the facility grounds and saw a two day supply of non-perishables and a 7 day supply of non-perishables in the facility kitchen. There was a variety of different proteins, vegetables, snacks, soda, water and juices available. LPA reviewed facility menu, which gives a variety of options and changes weekly. LPA Cifuentes interviewed clients (C1-R4). Of those interviewed, two were unable to answer questions due to their diagnosis and the other two stated facility provided them with a variety of foods for all three meals as well as snacks, water and juice. LPA interviewed staff (S1-S5) regarding the allegation. All five staff stated the facility an adequate amount of food to the residents in care.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Client is not provided comfortable accommodations while in care

It is alleged that facility is not providing a comfortable environment for the clients. LPA toured the facility grounds and saw a two day supply of non-perishables and a 7 day supply of non-perishables in the facility kitchen, there was a sufficient amount of linens available, bathrooms were clean and operational and facility ground were clean. LPA Cifuentes interviewed clients (C1-R4). Of those interviewed, two were unable to answer questions due to their diagnosis and the other two stated facility provided them with a comfortable environment. LPA interviewed staff (S1-S5) regarding the allegation. All five staff stated the facility an provided a comfortable environment for the clients.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Allegation: Uncleared adult is providing care and supervision

It is alleged that one of the staff in not fingerprint cleared and is working at the facility. LPA reviewed facility files and staff schedule, all staff currently employed are associated to the facility. LPA interviewed staff (S1-S5) regarding the allegation. All five staff stated they are fingerprint cleared and associated to the facility.

Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above.

Based on information gathered, the department did not find sufficient evidence to support allegations " Staff do not provide adequate food service for the client,” “Client is not provided comfortable accommodations while in care,” “Uncleared adult is providing care and supervision.”

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, therefore the allegations are Unsubstantiated.



An exit interview was conducted and a copy of this report left with Licensee Yosman Marroquin.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3