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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320147
Report Date: 07/12/2024
Date Signed: 07/15/2024 08:08:49 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240705142343
FACILITY NAME:ICAN CALIFORNIA ABILITIES NETWORK LONG BEACHFACILITY NUMBER:
198320147
ADMINISTRATOR:CLAIRE ROAFACILITY TYPE:
775
ADDRESS:4200E.PACIFIC COAST HWY.STE200TELEPHONE:
(310) 374-8295
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:18CENSUS: 95DATE:
07/12/2024
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:Executive Director Louise Elliots TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Client was hit while in care.
INVESTIGATION FINDINGS:
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On 07/12/24 Licensing program analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation above. LPA met with Executive Director Louise Elliot, as the purpose of the visit was explained.

The investigation consists of the following: On 07/12/24 LPA obtained copies of the following; staff and client roster, and the following for client #1 (C1) Harbor Regional Center facesheet, Harbor Regional Center IPP- Conference date: 03/15/2023, ICAN Admission agreement dated 05/07/24, Physicians report dated 05/22/24, and a copy of the Incident report dated 07/01/24. On 07/12/24 LPA Interviewed staff #1-4 (S1-S4), and client #1-4 (C1-C4). On 07/12/24 LPA Villegas toured the facility as well as reviewed survailance video dated 07/01/23.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
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 11-AS-20240705142343
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: ICAN CALIFORNIA ABILITIES NETWORK LONG BEACH
FACILITY NUMBER: 198320147
VISIT DATE: 07/12/2024
NARRATIVE
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The investigation revealed the following:

Allegation: Client was hit while in care.

It is being alleged that that someone at the day program hit C1’s hands. On 07/12/24 LPA interviewed Executive Director (S1) regarding the allegation above, S1 denied the allegation above and reported that when S1 was informed of the allegation above there was an immediate review of day program cameras and there was nothing on video to support the allegation. On 07/12/24 LPA interviewed S2-S4 regarding the allegation above, 3 of 3 staff interviewed denied the allegation above. On 07/12/24 LPA interviewed C1-C4, 4 of 4 clients interviewed denied the allegation above and reported feeling safe at the day program. On 07/12/24 LPA conducted a tour of the facility and there are no immediate health and safety concerns. On 07/12/24 LPA Villegas watch surveillance video of 07/01/24 and did not observe any evidence to support the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2