191222593-3-3-2023-31-AS-NMAN-CR8V6Y-20230425161015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191222593
Report Date: 03/03/2023
Date Signed: 03/03/2023 02:37:05 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230209111222

FACILITY NAME:	COMMUNICATION IMPROVEMENT GUIDANCE CENTER		FACILITY NUMBER:	191222593
ADMINISTRATOR:	AGBEDE, SONNY		FACILITY TYPE:	735
ADDRESS:	15030 SEPTO STREET		TELEPHONE:	(818) 891-6555
CITY:	MISSION HILLS	STATE: CA	ZIP CODE:	91345
CAPACITY:	6	CENSUS: 5	DATE:	03/03/2023
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Sonny Agbede - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff hit resident with an object

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted a subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Sonny Agbede and explained the reason for the visit.

LPA conducted physical plant tour at 9:00 AM, requested facility copy of facility documents relevant to the investigation at 9:35, interviewed addiditonal staff between 9:45 AM to 12:20 PM.

It was alleged that Resident #1 (R1) was hit by an object that looked like a belt by Staff #1 (S1) on 02/07/23 and in another incident looked like a whip by Staff #2 (S2) on 02/04/23. LPA was provided a copy of the video of the said hitting incident during the initial visit on 02/17/23 by the staff, the video taken on 02/04/23 only shows S2 was hitting own leg by the whip like object while standing near the door while looking at own cell phone. The video taken on 02/07/23 shows that R1 got out of the bathroom followed by S1 who was holding a belt, S1 was heard instructing R1 to put shirt on as R1 had no shirt on (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

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 31-AS-20230209111222

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: COMMUNICATION IMPROVEMENT GUIDANCE CENTER	FACILITY NUMBER: 191222593
	VISIT DATE: 03/03/2023

NARRATIVE

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(continued from LIC 9099)

LPA's interview with S1 today at 9:45 AM revealed that S1 was about to put own belt while following R1. S1 denied hitting S1 nor any other resident at the facility on S2's fifteen (15) years of working at the facility. LPA's interview with S2 today at 10:33 AM also revealed that S2 denied hitting R1 nor any other resident at the facility on S2's five (5) years of working at the facility. LPA's interview with the Administrator and Assistant administrator confirmed that there was no incident reported to them regarding S1 & S2 of any physical, verbal or any kind of abuse against any resident during their tenure at the facility. LPA's record review also confirmed that S1 & S2 had no record of any disciplinary action or report about any kind of abuse by any resident. LPA's interview with other staff on 02/17/23 between 11:00 AM to 2:00 PM working on the same shift with S1 and S2 during the alleged incident occurred, denied witnessing S1 or S2 hitting R1.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2023

LIC9099 (FAS) - (06/04)

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