198320321-11-12-2023-11-AS-MVAO-D3BUHE-20240313153549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320321
Report Date: 11/06/2023
Date Signed: 11/12/2023 08:08:06 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
10/31/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20231031151901

FACILITY NAME:	ATAP RESIDENTIAL HOME		FACILITY NUMBER:	198320321
ADMINISTRATOR:	WATERS, CORI		FACILITY TYPE:	735
ADDRESS:	11543 S. VAN NESS AVENUE		TELEPHONE:	(310) 292-8018
CITY:	HAWTHORNE	STATE: CA	ZIP CODE:	90250
CAPACITY:	4	CENSUS: 4	DATE:	11/06/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Cori Waters		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff pushed resident while in care
Staff yelled at resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, November 06, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Licensee Cori Waters. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews conducted with staff 1-2 (S1-S2) and clients 1-4 (C1-C4). LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker toured the entire facility to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during the visits. LPA Bunker reviewed clients' records. LPA Bunker requested copies of supporting documents. S1 stated she was not at the facility during the alleged incident.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

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-20231031151901

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: ATAP RESIDENTIAL HOME	FACILITY NUMBER: 198320321
	VISIT DATE: 11/06/2023

NARRATIVE

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See continued LIC9099-C page 2

Allegation #1: Staff pushed client while in care
During the investigation, LPA Bunker interviewed Staff 2 (S2) and Clients 1-4 (C1-C4), who reported being at the facility on 10/29/2023. According to their statements, staff did not push any clients into a wall in the hallway. S2 and C2-C4 also denied witnessing any incident where a client was grabbed by the shirt and pushed against the wall. While C1 mentioned being grabbed by his shirt, he stated he was not pushed by staff. All parties involved, including C1-C4 and S2, unanimously denied any occurrence of a pushing incident.

Allegation #2: Staff yelled at client while in care
LPA Bunker conducted interviews with Staff 2 (S2) and Clients 2-4 (C2-C4), revealing a consensus that staff does not engage in yelling at clients. C1, while mentioning the incident of yelling, couldn't recall specific details about the staff involved. C1 could not doesn't remember the staff name or what the staff looked like. All individuals present on 10/29/2023, including S2 and C1-C4, affirmed that no staff was observed yelling at a client. All parties, including S1-S2 and C2-C4, firmly denied the allegation.

The investigation consisted of the following: Interviews with Staff 1-2 (S1-S2) and Clients 2-4 (C2-C4), emphasizing their collective assertion that staff neither pushed nor yelled at any clients. Licensee Cori Waters stated she promptly self-reported the special incident report to relevant agencies, affirming the facility's zero-tolerance policy. S1-S2 emphasized their training and competence in meeting clients' needs, assuring that necessary precautions are taken to prevent harm. Both S1-S2 and C2-C4 unequivocally denied any physical or verbal abuse, with C1-C4 expressing contentment and satisfaction with the staff. S1-S2 and C2-C4 denied all allegations, underscoring the positive environment and care provided at the facility.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient 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 did or did not occur, therefore the allegation is deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099 and LIC9099-C was provided to the facility Licensee.
There were no deficiencies cited. An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023

LIC9099 (FAS) - (06/04)

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