198600187-2-18-2025-28-AS-RORN-DEH22X-20250305160128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600187
Report Date: 02/18/2025
Date Signed: 02/18/2025 11:52:15 AM

Unsubstantiated

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
02/10/2025 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250210105533

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:	02/18/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shianna Cato		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff mishandled the clients medication
Staff have inadequate record keeping for the clients

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced visit for the purpose of conducting initial complaint visit. On today's visit LPA met with Administrator Shianna Cato who assisted with today's visit.
At today's visit staff and client roster was submitted.
File for Client C1 was reviewed and Physician's Report, Medication Log and IPP were submitted.
Interview was conducted with Client C2.
Interviews were conducted with the Administrator and Staff S1- S2. Interviews were conducted with Regional Center Representative's.
Interview was conducted telephonically with Staff S1.
In regards to the allegation Staff mishandled the clients medication, based on interviews conducted and information gathered it was revealed by Staff S1 that medication was administered for Client C1 and there were no doses missed. Stated that she had corrected her mistake of not signing the MAR's Log and not
inputting the reason for given the medication on the back of the MAR's.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

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-20250210105533

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 - IZETTA	FACILITY NUMBER: 198600187
	VISIT DATE: 02/18/2025

NARRATIVE

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Also stated that the Administrator did not forge any initials or signatures.
Spoke with Regional Center Representative who was addressing these issues and stated that staff all said it was not forged and all staff said they sign their names and all medication was given.
Spoke with another Regional Center Representative who stated she has been service coordinator for 2 years for another client in the facility and said the MAR's is always available and that she makes 2 unannounced and 2 announced visits in the year and has never encountered a medication error. Said that she is new service coordinator for Client C1 and has not had any concerns regarding medication.
Spoke with Client C2 who stated that he has been here 7 years and has always had his medication administered and has never missed a dose.
Staff stated that medication is always given per physician's directions and no doses have been missed.
Administrator stated that all medication was administered per physician's directions and there has not been any clients who have missed a dose.
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.
In regards to the allegation Staff have inadequate record keeping for the clients, based on interviews conducted and information gathered it was revealed by Staff S1 that medication was administered for Client C1 and there were no doses missed. Stated that she had corrected her mistake of not signing the MAR's Log and not inputting the reason for giving the medication on the back of the MAR's.
Stated the Administrator did not forge her initials or signature.
Spoke with Regional Center Representative who was addressing these issues and stated that staff all said it was not forged and all staff said they sign their names.
Spoke with Regional Center Representative who stated she has been service coordinator for 2 years for another client in the facility and said the MAR's is always available and that she makes 2 unannounced and 2 announced visits in the year and has never encountered a medication error. Said that she is new service coordinator for Client C1 and has not had any concerns regarding medication administered.
Spoke with Client C2 who stated that he has been here 7 years and has always had his medication administered and has never missed a dose. Stated the staff who administer it also sign the MAR's.
Staff S2 stated that Staff S1 did not put her initials in MAR's and Staff S2 said she circled it and then Staff S1 went back and initialed it.
Administrator stated that Staff S1 made a mistake in not inputting initials into MAR's and another staff circled it and Staff S1 went back and corrected it.
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 conducted.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/18/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2025

LIC9099 (FAS) - (06/04)

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