198320360-7-17-2023-11-AS-EMAZ-CTWMFF-20230720093418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320360
Report Date: 07/17/2023
Date Signed: 07/17/2023 10:25:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/10/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20230710103537

FACILITY NAME:	OCEAN BREEZE CARE HOME III		FACILITY NUMBER:	198320360
ADMINISTRATOR:	MACELLVEN, GREGG		FACILITY TYPE:	740
ADDRESS:	1600 W 21ST		TELEPHONE:	(310) 721-9667
CITY:	SAN PEDRO	STATE: CA	ZIP CODE:	90732
CAPACITY:	6	CENSUS: 0	DATE:	07/17/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	ADMINISTRATOR GREGG MACELLVEN		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Uncleared individuals are residing in the facility.
Facility staff failed to ensure residents are afford a safe & healthful environment.

INVESTIGATION FINDINGS:

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On 07/17/2023 around 09:00 AM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation for Ocean Breeze Care Home III to deliver the investigation findings for the allegation listed above. LPA met with Administrator Gregg Macellven (A1) and the purpose of the visit was explained.

The investigation revealed the following:

During this investigation, LPA Calderon interviewed A1. These interviews were conducted on 07/17/2023, LPA Calderon obtained no records as facility has not opened and has no residents at this time. On 07/17/2023 LPA Calderon and administrator toured the facility.

Allegation 1: Uncleared individual are residing in the Facility.

It is alleged uncleared individuals are residing in the facility.
On 07/17/2023 LPA Calderon interviewed A1 for complaint. A1 relays that he just had his pre-license visit on 06/02/2023 from DSS and currently has no staff or residents in the facility. A1 relays that A1 family was living in the home from November 2022 to January 2023 and no one else lived in the home. A1 relays that A1 daughter did have a party in January 2023 and neighbors did complain to him about the noise and people coming and going at night. A1 relays that A1 daughter does not sell drugs and has no criminal record. On 07/17/2023 LPA Calderon toured the facility and no staff or resident living at the facility at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230710103537

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: OCEAN BREEZE CARE HOME III	FACILITY NUMBER: 198320360
	VISIT DATE: 07/17/2023

NARRATIVE

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Allegation 2: Facility staff failed to ensure residents to ensure residents are afford a safe & healthful environment.

It is alleged staff failed to ensure residents are afford a safe & healthful environment.
On 07/17/2023 LPA Calderon interviewed A1 for complaint. A1 relays that he just had his pre-licensee visit from DSS done on 06/02/2023 and he has no residents or staff living in the facility at this time. A1 relays that he will provide a clean and safe environment to staff and residents when he starts his business. A1 relays no drugs are sold in his facility, and no one lives in his home currently. On 07/17/2023 LPA Calderon and A1 toured the facility and found no residents living at the facility at this time and no staff working at the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) “uncleared individuals are residing in the facility”, “facility staff failed to ensure residents are afford a safe & healthful environment” did not occur, therefore the allegation is unsubstantiated.

A face-to-face meeting was conducted with Administrator Gregg Macellven, and a hard copy was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC9099 (FAS) - (06/04)

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