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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602174
Report Date: 04/17/2023
Date Signed: 04/17/2023 10:10:19 AM

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
04/11/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230411103833
FACILITY NAME:ALLEN'S PALM COVE CERRITOSFACILITY NUMBER:
198602174
ADMINISTRATOR:DIMAANO, EUPHROSYNEFACILITY TYPE:
740
ADDRESS:18714 KINGS ROW AVETELEPHONE:
(562) 866-3585
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:6CENSUS: 4DATE:
04/17/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:House Manager Christopher Gosioco TIME COMPLETED:
10:25 AM
ALLEGATION(S):
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Uncleared staff working at the facility.
INVESTIGATION FINDINGS:
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On 04/17/23 at 08:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation to the facility. Upon arrival LPA met with staff#1 (S1) and explained the reason for the visit. House Manager Christopher Gosioco Joined the visit at 8:50 am.

During today’s visit LPA toured the facility with S1, obtained resident/ staff roster, and staff schedule. LPA interviewed House Manager, S1 and S2. LPA also interviewed Residents # R1 through R3. R4 was sleeping and declined interview.

Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
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-20230411103833
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: ALLEN'S PALM COVE CERRITOS
FACILITY NUMBER: 198602174
VISIT DATE: 04/17/2023
NARRATIVE
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The investigation reveals the following: Regarding “Uncleared staff working at the facility “, it is alleged that the facility hires undocumented immigrants. Upon arrival LPA observed two (2) staff working at the facility. Both staff was check and observed to be associated. LPA toured the facility and did not observe additional staff members working at the facility. House Manager Christopher Gosioco provided LPA with a staff roster and weekly schedule. LPA cross referenced both documents with association list printed 04/11/23 and all names listed were cleared. House Manager Gosioco stated all staff is associated and fingerprinted prior to them starting work at the facility. During the interview S1 and S2 named all staff they have worked with, and all are associated to the facility. Residents R1 through R3 named staff that usually assist them in the facility, and all are associated to the facility. R4 refused interview.

Based on LPA's interviews, file review and observation the investigation revealed: 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 conducted with House Manager Christopher Gosioco and a copy of this record provided.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2