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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197801279
Report Date: 08/11/2021
Date Signed: 10/04/2021 04:03:05 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 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
08/03/2021 and conducted by Evaluator LaJean Nicole Spencer
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210803135523
FACILITY NAME:LEANING PINE, THEFACILITY NUMBER:
197801279
ADMINISTRATOR:VILLAFLOR, ELNA C.FACILITY TYPE:
740
ADDRESS:1809 LEANING PINE DRIVETELEPHONE:
(909) 396-4675
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:6CENSUS: 6DATE:
08/11/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elna Villaflor, administratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff does not safeguard residents' belongings.
Facility staff open residents' mail.
INVESTIGATION FINDINGS:
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***This is an amended report and supercedes report dated 8/11/21. Additional details were added, but the findings were not changed.***

Licensing Program Analyst (LPA) Nicole Spencer conducted an initial complaint investigation for the allegations listed above. LPA Spencer was met with staff#1 and was later met by administrator Elna Villaflor and discussed the purpose of today's visit.

During the investigation, LPA Spencer took a tour of the physical plant and interviewed the administrator, staff #1-2 (S1-S2), residents #1-6 (R1-R6), and family members of a resident (F1-F2). R5 was non-verbal so the interview was discontinued, and F1 was unable to be reached. LPA Spencer obtained a copy of the staff roster, resident roster, admissions agreement and all resident files were reviewed.

*Continued on LIC9099C*
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
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 5
Control Number 28-AS-20210803135523
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LEANING PINE, THE
FACILITY NUMBER: 197801279
VISIT DATE: 08/11/2021
NARRATIVE
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***This is an amended report and supercedes report dated 8/11/21. Additional details were added, but the findings were not changed.***

The investigation consisted of the following: Regarding the allegation that facility staff does not safeguard residents' belongings, LPA Spencer reviewed the admissions agreement showing the facility's theft and loss policy includes inventory of residents personal property and valuables. LPA reviewed residents' files and observed that all residents had a completed personal property and valuables inventory list. Interviewed staff stated that if residents report missing items, the staff will look for the items, inform the responsible party, and replace the item if not found. Staff stated that any missing items are usually found in the resident's room. Three (3) out of five (5) residents stated that they have not had missing items, while two (2) out of five (5) stated they were missing items such as clothing and important papers. However, the resident reporting missing clothing stated that it was stolen by a staff member whose name was not listed on the staff roster, and the resident who stated they were missing important papers stated in a follow-up interview that it was later found in the resident's room.

Regarding the allegation that staff open residents' mail, all staff interviewed stated that residents' mail is given to the residents' responsible party unless the resident is self responsible, independent and gets their own mail. All staff denied the allegation that staff open the residents' mail. The administrator stated that R6's mail was mistakenly forwarded to the administrator's P.O. Box and was partially opened and crumpled but gave it to the resident and explained what happened. The administrator stated that the mail was never opened by facility staff and it was likely damaged at the post office during the sorting of the mail. Four (4) out of five (5) residents stated that their family gets their mail and were unaware of staff opening residents' mail, while one (1) out of five (5) stated that two letters were pre-opened when the resident received it.

Based upon interviews conducted and records reviewed, the findings indicate although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are Unsubstantiated.

An exit interview was conducted with Administrator Elna Villaflor and a hard copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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 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
08/03/2021 and conducted by Evaluator LaJean Nicole Spencer
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20210803135523

FACILITY NAME:LEANING PINE, THEFACILITY NUMBER:
197801279
ADMINISTRATOR:VILLAFLOR, ELNA C.FACILITY TYPE:
740
ADDRESS:1809 LEANING PINE DRIVETELEPHONE:
(909) 396-4675
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:6CENSUS: 6DATE:
08/11/2021
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elna Villaflor, administratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Resident is not allowed to go outside the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicole Spencer conducted an initial complaint investigation for the allegations listed above. LPA Spencer was met with staff #1 and was later met by administrator Elna Villaflor and discussed the purpose of today's visit.

During the investigation, LPA Spencer took a tour of the physical plant and interviewed the administrator, staff #1-2 (S1-S2), residents #1-6 (R1-R6), and family members of a resident (F1-F2). R5 was non-verbal so the interview was discontinued, and F1 was unable to be reached. LPA Spencer obtained a copy of the staff roster, resident roster, and admissions agreement and all resident files were reviewed.

The investigation consisted of the following: Regarding the allegation that residents are not allowed to go outside of the facility, all staff interviewed stated that due to the pandemic, residents are not being allowed to go out but they are allowing visitors to come and visit residents. *Continued on LIC9099C.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20210803135523
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: LEANING PINE, THE
FACILITY NUMBER: 197801279
VISIT DATE: 08/11/2021
NARRATIVE
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Three (3) out of five (5) residents interviewed stated that residents are not allowed to go outside of the facility at this time, one (1) of out five (5) stated that they are allowed to go in the backyard and have outings with family members once in a while, and one (1) stated that they were unsure. F2 stated that family members were previously taking R6 on outings and the facility was allowing R6 to go out independently, but recently the family has refused to provide transportation due to family disputes. In a follow-up interview with the administrator, the administrator clarified that they were previously allowing R6 to go out on outings using Dail-a-ride or arranging transportation through family, however, due to family disputes, the administrator did not allow the resident to leave based on the family's request. A review of R6's records shows that the resident is not conserved and can leave the facility unassisted. Per admissions agreement, the basic services include assistance with transportation.

Based upon interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report was provided to the Administrator along with the Appeals Rights.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20210803135523
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LEANING PINE, THE
FACILITY NUMBER: 197801279
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/11/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/13/2021
Section Cited
CCR
87468.1(a)(6)
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87468.1(a)(6) Personal Rights of Residents in all facilities. To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by...
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The administrator stated that she would provide in-service training regarding PINS about visitations and outings during COVID-19 and provide a copy of the relevant PINS to staff and residents. Administrator will provide a copy of training log to CCL by 8/13/21.
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Based on interviews and records reviewed, the licensee did not ensure that residents were not restricted from leaving the facility. This poses a potential risk to the personal rights of persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: LaJean Nicole Spencer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/11/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5