198600187-7-7-2023-28-AS-MVAO-CTPQ66-20230713115300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600187
Report Date: 07/07/2023
Date Signed: 07/07/2023 11:32:07 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/29/2022 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220729084547

FACILITY NAME:	CHOICES R US - IZETTA		FACILITY NUMBER:	198600187
ADMINISTRATOR:	DANIEL GODFREY		FACILITY TYPE:	735
ADDRESS:	12103 IZETTA AVE		TELEPHONE:	(562) 869-5135
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	4	CENSUS: 4	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Gil Martinez - Assistant Administrator / DSP		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff pushed resident
Resident is not allowed to leave the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Gil Martinez Assistant Administrator / DSP and explained the reason for the visit. Administrator Marc Sweet arrived shortly thereafter.

The investigation revealed the following: during the initial visit conducted on 08/03/2022, LPA Kruz Long conducted a tour of the facility. During the visit LPA Long obtained staff and client files, and also interviewed Staff #1 (S#1). During today's visit, LPA Zaragoza interviewed Clients 1 - 4 (C#1, C#2, C#3, C#4), Staff #3 - 5 (S#3, S#4, S#5). LPA attempted to interview (S#2), however S#2 is no longer an employee of the facility. LPA also obtained copies of the following documentation for C#1: FACE Sheet, Individual Program Plan (IPP), and Physician's Report. LPA also obtained copies of Physician's Reports for C#2 - C#4.

The investigation revealed the following: in regards to the allegation "Staff pushed resident", it is alleged that Staff #2 (S#2) pushed C#1 against a door when C#1 attempted to leave the facility.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 28-AS-20220729084547

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CHOICES R US - IZETTA	FACILITY NUMBER: 198600187
	VISIT DATE: 07/07/2023

NARRATIVE

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During an interview with C#1 while at the facility, client denied that he was ever pushed by any staff during his stay at the facility and that no staff or anyone else has put their hands on him. During interviews with clients # 2 - 4 (C#2, C#3, C#4) the clients explained that none of them have ever had problems with the facility staff pushing them or putting their hands on them in the facility. Interviews with Staff #3 - 5 (S#3, S#4, S#5) revealed that no staff within the facility in the facility have ever pushed or physically put their hands on the clients.

In regards to the allegation "Resident is not allowed to leave the facility", it is alleged that S#2 told C#1 that he could not go outside and held the door shut in order to prevent the client from leaving. During interview with C#1, the client stated that he has never been prevented from leaving the facility when he wanted to and has never had any issues with staff holding his door closed to stop him from leaving the facility. During interviews with C#2 - C#4, all clients denied ever being prevented from leaving the facility when they wish to. During interviews with S#3 - S#5, they explained that they have never prevented a client who wanted to leave the facility from doing so. They also explained that C#1 and C#2 are able to leave the facility unassisted, and that they need only to sign out of the facility and explain where they are going and for how long they will be gone when doing so. The other two clients C#3 and C#4 however can not leave the facility unassisted as indicated by the physician's reports, so they do need to notify staff and be accompanied by them whenever they want to leave the facility. However staff explained they have never physically restrained or prevented a client from leaving the facility.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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