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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608164
Report Date: 06/14/2024
Date Signed: 06/14/2024 11:16:41 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2024 and conducted by Evaluator Christian Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240510120215
FACILITY NAME:ROLYN HOMEFACILITY NUMBER:
197608164
ADMINISTRATOR:RONALD MANALADFACILITY TYPE:
740
ADDRESS:10622 LEEDS STREETTELEPHONE:
(562) 868-1560
CITY:NORWALKSTATE: CAZIP CODE:
90650
CAPACITY:6CENSUS: 4DATE:
06/14/2024
UNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Eadgitha Manalad DSPTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Client does not feel safe in the home.
Client is scared of the home staff.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christian Gutierrez and Licensing Program Manager (LPM) Tony Vasallo conducted a subsequent complaint visit to investigate the allegations listed above. LPA Nicol Wesley conducted initial visit on 5/20/2024. LPA and LPM met with DSP Worker Eadgith Manalad and explained the reason for the visit.

The investigation consisted of the following: Obtain documents of resident and staff files, conduct staff, and resident interviews. Requested a copy of staff and resident roster.

The investigation revealed the following: Allegation #1 Resident does not feel safe in the home. Allegation #2 Resident is scared of home staff. Its alleged Residents #1 (R1) complains of pain and is ignored and told they are drama and exaggerates.
Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
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 28-AS-20240510120215
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ROLYN HOME
FACILITY NUMBER: 197608164
VISIT DATE: 06/14/2024
NARRATIVE
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Four out of four staff interviewed did not collaborate this allegation and they are unaware of any residents feeling unsafe. Staff denied any abuse in home. Three out of four residents were present and interviewed. It was confirmed Residents #2 (R2) is nonverbal therefore unable to be interviewed. Other two residents interviewed cannot give detailed responses to questions and answers were inconsistent. However, both residents reported feeling safe at home. R1’s records were reviewed. R1’s Individual Program Plan (IPP) dated 11/20/23 revealed R1 has a history of false allegations and fabricating mistreatment by staff. Five staff records were reviewed and did not contain any disciplinary actions. Based on interviews conducted and records reviewed there was insufficient evidence to collaborate these allegations.

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.

Exit interview held. A copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2