198600085-9-16-2021-28-AS-LHIS-C72UGC-20210920153408

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600085
Report Date: 09/16/2021
Date Signed: 09/16/2021 08:23:08 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/08/2019 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20190608141535

FACILITY NAME:	CHOICES R US - WOODHUE		FACILITY NUMBER:	198600085
ADMINISTRATOR:	BRADFORD, SHAJUANA		FACILITY TYPE:	735
ADDRESS:	9523 WOODHUE ST		TELEPHONE:	(562) 942-1419
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	6	CENSUS: 6	DATE:	09/16/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Adeshola Obayo		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Facility staff failed to adequately supervise residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted another visit to issue the final results of the investigation. LPA met with Administrator, Adeshola Obayo who assisted with today's visit.

Regarding the allegation that facility staff failed to adequately supervise residents in care, the investigation consisted of interview with Administrator, review of the following : Regional Allocation of Police Services (RAP) Report from Pico RIvera Sheriff Department dated 6/3/18-6/3/19, facility staff schedule, resident and staff roster(s) and review of Resident IPP reports.

The investigation revealed the following: Review of RAP report indicates that the Pico Rivera Sheriff department were called numerous times during the period of 6/3/18 - 6/3/19, for different reasons including residents fighting, neighbors contacting sheriff due to resident yelling and throwing trash bins outside, resident assaulting staff member, etc. The Sheriff Department was called 15 times during the period reviewed. Administrator did not deny the allegation, nor did he deny the calls for assistance made to the Pico Rivera Sheriff Department. Review of Staff schedule indicates that there are two staff on schedule in the morning, three to four staff in the afternoon, and two staff in the evening.

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

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 28-AS-20190608141535

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WOODHUE	FACILITY NUMBER: 198600085
	VISIT DATE: 09/16/2021

NARRATIVE

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Administrator stated that facility staff are no longer calling sheriff department for client behaviors that can be handled by facility staff.

Based on LPA's observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 28-AS-20190608141535

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - WOODHUE	FACILITY NUMBER: 198600085
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/17/2021 Section Cited CCR 80078(a)	1 2 3 4 5 6 7	Responsibility for providing care and supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by: LPA observed that facility staff called Pico RIvera Sheriff station numerous times during the period of 6/3/18- 6/3/19.	1 2 3 4 5 6 7	Administrator will ensure that the facility has adequate staff to provide care and supervision to all residents in care. Administrator will provide a staff in service training to LPA by POC due date.
	8 9 10 11 12 13 14		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: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Angelica Rea
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021

LIC9099 (FAS) - (06/04)

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