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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601959
Report Date: 05/20/2025
Date Signed: 05/21/2025 01:12:10 PM

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
05/13/2025 and conducted by Evaluator Sanjay Vaid
COMPLAINT CONTROL NUMBER: 28-AS-20250513133628
FACILITY NAME:MOM & DAD'S HOUSEFACILITY NUMBER:
198601959
ADMINISTRATOR:IVONNE A. MEADERFACILITY TYPE:
740
ADDRESS:4340 CONQUISTA AVE.TELEPHONE:
(562) 627-0390
CITY:LAKEWOODSTATE: CAZIP CODE:
90713
CAPACITY:6CENSUS: 5DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Licensee Ivonne MeaderTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Residents in care have access to hazardous items in the facility.
Facility is not equipped with sufficient food items for residents in care.
Staff did not ensure the facility was kept free of pest.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sanjay Vaid conducted a 10-day complaint investigation at the facility and was allowed entry by April Silva Caregiver. April informed the Administrator -Elsa Roman who later joined and discussed the visit. Conducted tour with Elsa and did not observe any health and safety concerns. Licensee Ivonne Meader arrived shortly after and assisted with the complaint.

LPA Vaid request obtained and reviewed the following documents: Client roster, staff roster, copy of four (4) weeks of grocery list ordered and four week grocery receipts, pest control product receipts, five (5) residents physicians reports. Five residents’ interviews were attempted, two residents are non-verbal and could not provide information on the complaints, three residents were interviewed.

Regarding the allegation: Residents in care have access to hazardous items in the facility. It is alleged that the residents have access to hazardous items and staff is not doing anything to stop this. Four (4) out of four (4) staff interviewed deny this. According to the staff their first duty of the shift is to make visual observations and look for any hazards that may cause residents’ harm. Continued on 9099C............
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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 28-AS-20250513133628
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: MOM & DAD'S HOUSE
FACILITY NUMBER: 198601959
VISIT DATE: 05/20/2025
NARRATIVE
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LPA Vaid toured the facility interior and exterior and did not observe any obstructions throughout the pathways of the facility, nor observed hazardous items left out. Staff stated they have residents that wander around the facility and staff are always making sure that residents do not have access to hazardous items. LPA observed all sharps and cleaning products locked and inaccessible to residents. Five (5) out of five (5) residents interviewed could not corroborate this allegation. Residents have not seen any hazardous items at the facility. During LPA’s tour of the facility, did not observe hazardous items at the facility. Based on interviews conducted with facility staff, residents, and observations made the preponderance of evidence standard has been met; therefore, the above-mentioned allegations are found to be unsubstantiated.

Regarding the allegation: Facility is not equipped with sufficient food items for residents in care. It is alleged that the facility staff is not providing the residents with enough food for their wellbeing. Four (4) out of four (4) staff interviewed deny this allegation. According to the staff a grocery list is complied throughout the week and order is placed through three vendors and deliveries are made to the facility on Fridays. LPA observed 2-day perishables and 7 day non-perishable, extra food items in the second fridge and water are stored in the garage storage area. Four weeks of grocery list and receipts were provided to LPA. Two (2) out of five (5) residents interviewed could not corroborate this, according to residents interviewed they have access to extra-food can have special meals prepared. LPA Vaid observed lunch served in large portions to residents. Based on interviews conducted with facility staff, residents, observations made, and records reviewed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Staff did not ensure the facility was kept free of pest. It is alleged that the staff is not keeping pests (cockroaches and rodents) from infesting the facility. Four (4) out of four (4) staff interviewed deny this allegation, they have never had pest problems at the facility. According to Licensee Ivonne Meader, the facility was proactive in calling pest control company after the staff reported seen dropping on 5/5/25 and called the pest control company on 5/6/25, that advised the facility with placing contained high-voltage shock rodent traps around the facility. Pest control technician contacted on 05/06/24 concluded based on the information received of droppings found in only three places of the facility and through pest control technicians experience that the facility did not have a pest problem. The licensee will call pest control company if pest/droppings are observed in the facility. The pet therapist had visited the facility on 5/5/25 with four service animals for the residents, all animals were accounted for after the visit. The pet therapist uses blanket for the animals in case the animals defecate. The pet therapist confirms they check the area for dropping from the service animals before leaving the facility. Continued on 9099C.................
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250513133628
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: MOM & DAD'S HOUSE
FACILITY NUMBER: 198601959
VISIT DATE: 05/20/2025
NARRATIVE
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The droppings were concluded to be of the service pets. There have been no reported sightings of pest or droppings after the pet therapists visit on 5/5/25, according to staff interviewed. Five (5) out of five (5) residents interviewed could not corroborate this allegation. LPA Vaid checked under the kitchen and bathrooms cabinets with a flashlight and did not observe any presence of pests or dropping in the kitchen or bathrooms cabinets. Based on interviews conducted with facility staff, residents, observations made. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted and copy of this report was provided to Licensee Ivonne Meader.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Sanjay Vaid
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3