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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608164
Report Date: 11/12/2024
Date Signed: 11/12/2024 03:58:35 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
11/05/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241105160017
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: 3DATE:
11/12/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Eadgitha Manalad, StaffTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility staff handled resident in a rough manner.
Facility staff did not provide resident with a call bell.
Facility staff spoke inappropriately to resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted the complaint investigation on 11/12/24. LPA arrived unannounced and met with Staff Eadgitha Manalad. The purpose of the visit was explained.

LPA toured the facility and obtained copies of documents pertaining to Resident #1. Interviews were held with the Administrator, Staff #1 - #4, Residents #1 - #3, and the Harbor Regional Center Service Coordinator.

The investigation revealed the following:
Allegation – Facility staff handled Resident in a rough manner. It is alleged that Staff #1 (S1) pulled Resident #1’s (R1) leg too hard, causing it to pop. LPA interviewed the administrator, Staff, and Residents regarding this allegation. All the Staff denied handling residents in a rough manner. S1 denied pulling R1’s leg. S1 stated that R1 needed to be rotated during diaper change so that resident can be cleaned thoroughly and to adjust the diaper.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
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-20241105160017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ROLYN HOME
FACILITY NUMBER: 197608164
VISIT DATE: 11/12/2024
NARRATIVE
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S1 denied hearing a pop sound and did not think resident was handled roughly but said that R1 demanded an apology in which S1 did. The administrator and staff were not aware of this occurrence until R1 reported to a third party. They stated R1 will let them know of any concerns, however, R1 did not mention this incident to them. Two of the residents interviewed do not feel that staff are being rough with them.

Allegation – Facility staff did not provide resident with a call bell. The administrator and staff stated the call bell is placed next to R1 on the bed to request for staff’s assistance. In addition, the door is open or closed based on resident’s preference. They stated that R1 will usually call out the names of the staff instead of using the bell. Staff said that R1 has the tendency of dropping the bell from the bed and when staff see it on the floor, they will pick it up and put it back on the bed. Staff denied closing the bedroom door against resident’s wish to prevent staff from hearing them. Staff stated they check on residents throughout the day and will assist them at night when needed. Staff will ask residents if they want their doors open or closed. During the tour, LPA observed the bell in R1’s room and the door propped slightly open. Residents interviewed stated the staff assist them when needed.

Allegation – Facility staff spoke inappropriately to resident. The administrator and staff denied yelling or accusing resident of being too noisy or bothersome to others. If a resident is being loud, staff would ask resident to lower the voice and explain the reason. They do not yell or raise their voice at them. Staff stated sometimes they talk loudly but not in a way to disrespect others. Staff are cautious with their choice of words and do not say or do anything that will violate their personal rights. Two of the residents stated that staff do not yell or say inappropriate things to them.

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 with the E. Manalad. A copy of this report along with the appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2