197801689-5-8-2025-28-AS-DSIS-DJSTWM-20250721150543

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197801689
Report Date: 05/08/2025
Date Signed: 05/08/2025 02:25:42 PM

Substantiated

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
04/17/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250417111548

FACILITY NAME:	FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED		FACILITY NUMBER:	197801689
ADMINISTRATOR:	TAMARU FRANCIS		FACILITY TYPE:	735
ADDRESS:	715 E. CHESTER ROAD		TELEPHONE:	(626) 858-1803
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	6	CENSUS: 6	DATE:	05/08/2025
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Kiara Ponds, DSP		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Illegal eviction.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Daniel Konishi conducted an unannounced subsequent 10-day complaint visit at the facility and met with Kiara Ponds, DSP (Direct Support Professional) to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegations.

On 04/24/2025, the initial investigation visit was conducted. The investigation consisted of the following:
LPA interviewed the Administrator, Licensee, Staff #1 (S1). LPA also obtained the staff and client rosters. LPA reviewed C1’s file: admission agreement, Individual Program Plan (IPP), physician's report, and Doctor's notes.

On 04/28/2025, LPA interviewed Witness #1 (W1) over the phone.

On 05/05/2025, LPA interviewed Witness #2 (W2) and Witness #3 (W3) over the phone.

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

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 6

Control Number 28-AS-20250417111548

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
	VISIT DATE: 05/08/2025

NARRATIVE

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On 05/07/2025, LPA interviewed Client #1 (C1) to Client #6 (C6), Witness #4 (W4) to Witness #6 (W6) over the phone.

The investigation revealed the following: in regards to the allegation “Illegal eviction.” It is alleged that the facility issued a 30-day eviction notice to C1 although they had done nothing wrong to warrant the eviction. All the staff interviewed denied the allegation. Per 30-day eviction notice dated 04/07/2025, the eviction notice indicates the following reasons for the eviction: Communication Breakdowns, Impact on Other Residents, Program Participation Issues, and Behavioral Consequences. However, this 30-day eviction notice dated 04/07/2025 for C1 does not list specific facts including the date, place, witnesses, and circumstances for the eviction as required per Title 22 Regulations. Additionally, LPA reviewed Special Incident Reports (SIRs) that have been submitted by the facility and there are no SIRs on record that have been submitted to the Department regarding issues and/or concerns related to C1. The Department also has no documented records of C1 being a threat to the health and safety of themselves and/or other clients. Eviction letter also indicates that C1 is being evicted due to communication breakdowns between C1’s family member and the facility. LPA interviewed C1 regarding the eviction letter but C1 was unable to provide an answer to the allegation. There is enough evidence to substantiate.

Based on LPAs observations and interviews which were conducted, 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 and Chapter 1 is being cited on the attached LIC 9099D.

Exit interview held with the Kiara Ponds, DSP and a copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 28-AS-20250417111548

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/08/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/22/2025 Section Cited CCR 85068.5(c)	1 2 3 4 5 6 7	(c) The licensee shall set forth in the notice to quit the reasons for the eviction, with specific facts including the date, place, witnesses, and circumstances. The requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator/Licensee to rescind eviction letter dated 04/07/2025. Administrator to resubmit new eviction letter with new effective date that meets eviction procedures found in 85068.5 and 80068.5.
	8 9 10 11 12 13 14	Per 30-day eviction notice dated 04/07/2025, the eviction notice for C1 does not list specific facts including the date, place, witnesses, and circumstances. This poses a potential health/safety risk to the clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
04/17/2025 and conducted by Evaluator Daniel Konishi

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250417111548

FACILITY NAME:	FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED		FACILITY NUMBER:	197801689
ADMINISTRATOR:	TAMARU FRANCIS		FACILITY TYPE:	735
ADDRESS:	715 E. CHESTER ROAD		TELEPHONE:	(626) 858-1803
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	6	CENSUS: 6	DATE:	05/08/2025
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Kiara Ponds, DSP		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff refused clients responsible party entry to the facility.
Staff did not ensure clients health care needs were met in a timely manner.
Staff did not safeguard inventory clients personal property upon admission.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 28-AS-20250417111548

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
	VISIT DATE: 05/08/2025

NARRATIVE

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On 05/07/2025, LPA interviewed Client #1 (C1) to Client #6 (C6), Witness #4 (W4) to Witness #6 (W6) over the phone.

The investigation revealed the following: in regards to the allegation “Staff refused clients responsible party entry to the facility.” It is alleged that visitor visits C1 on a weekly basis and the staff typically don't allow the visitor to come inside the facility or see C1’s room and only been inside the home 2 times. On another occasion, the staff refused the visitor entry and had to wait outside. All the staff interviewed denied the allegation. W1 to W3 denied the allegation stating staff allow them to enter the facility when they visit. W6 denied the allegation. C1 to C4 all denied the allegation and stated that their families are allowed to enter the facility. C5 and C6 both answered that they have no visitors that come to the facility. There’s not enough evidence to substantiate.

Allegation: “Staff did not ensure clients health care needs were met in a timely manner.” It is alleged that C1 did not seek treatment in a timely manner when C1 had an ear infection. All staff interviewed denied the allegation. W1 to W3, and W6 interviewed denied the allegation. Admin indicated that C1 first met with the physician on 07/07/2023 and C1 had concerns about the ear infection on 08/01/2023 in which a referral was made. LPA received confirmation from C1’s physician office over the phone on the day of the visit. Based on an interview with W5 over the phone, W5 which also indicated that based on C1’s insurance accepted the only ENT doctor that scheduling an initial appointment takes at least five to six months. W5 stated that a consultation appointment was scheduled on 04/17/2024 and the ear infection was resolved on 05/07/2024. A follow up appointment was scheduled on 05/06/2025 in which C1 attended and there was no issues noted. W6 also stated that C1’s primary contact is informed about C1’s condition via email and phone call and C1’s primary contact has been invited to monthly meetings to discuss about C1. C2 to C6 denied the allegation and stated that staff provides medical assistance immediately and provides transportation to doctor appointments. There is not enough evidence to substantiate.

[Continue in LIC9099-C]

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 28-AS-20250417111548

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: FIRST CHANCE FOR THE DEVELOPMENTALLY DISABLED	FACILITY NUMBER: 197801689
	VISIT DATE: 05/08/2025

NARRATIVE

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Allegation: Staff did not safeguard inventory clients personal property upon admission. It is alleged that the facility staff never safeguard inventoried all of C1’s personal property when C1 was admitted to the home. All staff interviewed denied the allegation. Admin provided C1’s Personal Property and Valuables LIC621 form. C1 to C6 denied the allegation and stated that their personal belongings are kept safe while in care. C1 to C6 also stated that their belongings have not been lost or stolen. C1 to C6 all stated that they feel safe at the facility. W1 to W3 denied the allegation. W6 denied the allegation stating that staff would take inventory and there have never been a shortage of essential personal items for C1. There is not enough evidence to substantiate.

Based on LPAs observations and interviews which were conducted, record reviews, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED.

Exit interview held with the Kiara Ponds, DSP and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025

LIC9099 (FAS) - (06/04)

Page: 6 of 6