198320155-2-9-2024-11-AS-UCOL-DA52BW-20241016171545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320155
Report Date: 10/13/2023
Date Signed: 02/09/2024 01:49:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20231003103454

FACILITY NAME:	REM CALIFORNIA LLC - BALTIC		FACILITY NUMBER:	198320155
ADMINISTRATOR:	WHITLEY JOHN		FACILITY TYPE:	735
ADDRESS:	2800 BALTIC AVE		TELEPHONE:	(562) 424-9555
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90810
CAPACITY:	3	CENSUS: 3	DATE:	10/13/2023
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	MANAGER KENDALL EDWARDS		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained injury due to staff not preventing resident from being physical abuse by another resident

INVESTIGATION FINDINGS:

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THIS REPORT SUPERSEDES THE REPORT DATED 10/13/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to REM California LLC -Baltic facility on 10/13/2023 and was greeted by Manager Kendall Edwards (S3). LPA Calderon spoke to S3 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
During this investigation, LPA Calderon interviewed staff S1-S3 and interview clients C1-C3. These interviews were conducted on 10/13/2023. On 10/13/2023 LPA Calderon obtained and reviewed the following: Physician Report (dated 09/22/2023), Individual Service Plan (ISP) (dated 11/5/2020 and 08/04/2023), Incident reports (dated 10/02/2023), Behavioral consulting board analysis (BCBA) (dated 10/09/2023) for C1-C2. Conflict/redirection training for staff (dated 10/04/2023), Weekly reinforcer behavior plan for C2 training (date 09/26/2022), Safety Net training (dated 09/28/2023)
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

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 11-AS-20231003103454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: REM CALIFORNIA LLC - BALTIC	FACILITY NUMBER: 198320155
	VISIT DATE: 10/13/2023

NARRATIVE

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Regarding Allegation #1: C1 sustained injury due to staff not preventing C1 from being physically abused by another client.This complaint alleged that C1 attacked C2, and staff did not prevent the assault. On 10/13/2023 LPA Calderon obtained and reviewed the following: Reviewed the reinforcer behavior plan (dated 09/26/2022) for C2. The behavior plan gives staff options to redirect C2 aggressive behavior. Staff training Logs (dated 09/28/2023 and 10/04/2023). Training logs for “safety first” and “redirection” gave advice for staff on how to deal with client’s aggressive behaviors. LPA Calderon reviewed Individual Service Plan (ISP) (date 08/04/2023) for C2. ISP states C2 gets frustrated when C2 can’t express C2 clearly or when staff don’t understand what C2 is trying to say. Staff will support C2 by directing C2 to C2 calendar as a reminder of when those activities will happen. Reviewed incident report (date 10/02/2023). There is no report or history of C2 being aggressive with staff or other clients. LPA Calderon conducted an interview with Manager Kendall Edwards (S3). S3 states that S3 has provided redirection training to staff on 09/26/2022, 09/28/2023 and 10/04/2023. A1 states that S1-S2 have been trained to redirect C2 anger. LPA Calderon interviewed 2 out of 2 staff #1-#2 (S1-S2) reported that.Manager S3 has provided redirection training and follow-up training for clients’ aggressive behaviors. Two out of two staff state that they could not have prevented C2 from attacking C1. LPA Calderon conducted an interview with S2. S2 states that S2 was making breakfast for C1-C3. S2 states that S2 was not paying attention to C2 who got mad at S2. C1 and C2 were not in front of S2 when the attack happened. S2 states that S1-S2 redirect C2 anger moods and speaks to C2 which calms C2 down. S2 states that C1 was not taken to the hospital and was not injured. LPA Calderon interviewed 3 out of 3 clients #1-#3 (C1-C3) reported that.C2 had punched C1 in the eye for unknown reasons. C1 states that C1 was not injured from the punch to C1 left eye and was not taken to the hospital. C2 states that S2 was not listing to what C2 had to say and C2 got mad. C2 states that C1 was making faces at C2 and C2 got mad and punched C1 in the face. C3 states that C3 did not know what happened between C1 and C2 and did not witness the attack, but that C3 has not had any issues with C2. Reviewed weekly reinforcer behavior training plan for C2 (dated 09/26/2022) training to provide additional motivation at home throughout the week. Staff training to observe C2 for behavioral changes and if client will be able use Netflix weekly. Reviewed the employee safety intervention steps training (dated 10/04/2023), behavioral coaching, when to intervene and not to intervene during escalation from an individual, use of correct verbiage.Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “Resident sustained injury due to staff not preventing resident from being abused by another resident” is found to be UNSUBSTANTIATED. An exit interview was conducted and copy of the Complaint Report were provided to the Manager Kendall Edwards (S3)

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023

LIC9099 (FAS) - (06/04)

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