198600187-3-20-2025-28-AS-RORN-DF4U9Q-20250325152327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600187
Report Date: 03/20/2025
Date Signed: 03/20/2025 04:51:40 PM

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
03/11/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250311170823

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: 3	DATE:	03/20/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Katia Ocampo		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Facility is not operating within staffing ratios
Administrator is coaching staff to not discuss allegations
Facility has an insufficient food supply
Staff are mismanaging client’s medications

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced initial 10-Day complaint investigation regarding the above allegations. LPA meet with Katia Ocampo. Shortly after Co Administrator and Assistant QA ( Quality Assurance) were arrived and assisted with the visit. The purpose of the visit was explained.

The investigation consisted of the following: LPA toured the facility, Reviewed and obtained copies of Staff & Clients Rosters, Staff schedule, time sheet record, Staff in service training for Medication Administration, Error Prevention, Destroing Medications, Medication Distruction Record, Meal planner, Grocery shopping receipts for the month of March. LPA Revewed Medication Administration Records (MAR) for clients. Co Administrator, Staff 1(S1), Staff 2(S2), Client 1 (C1), Client 2 (C2) and Client 3 (C3) were intervewed. At the time of visit Sign language Interpreter for C2 was present and was interviewed also.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

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-20250311170823

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: 03/20/2025

NARRATIVE

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The investigation revealed the following: In regards to the allegation: Facility is not operating within staffing ratios. It was alleged that facility staff hours were cut which leave the facility without staffing ratio.
Interviewed Co administrator and staff denied the allegation. They stated that Regional Center ( South Central Los Angeles Regional Center) mandates a ratio 1:2 and the facility are within staff ratio. Interviewed co administrator stated that the facility also hires staff from outside agencies to meet staffing ratio requirements. Staff reported that they have only 3 clients at the facility and they have enough staff to provide adequate services to clients. Interviewed Interpreter stated that she/he at the facility 5 days a week from 8:00am -8:00pm and there are always 2 - 3 staff at the facility. Interviewed clients reported staff are taking good care of them and they are able to assist their needs and they feel safe living in the facility. Clients stated that there are always 2-3 staff at the facility.

In regards to the allegation: Administrator is coaching staff to not discuss allegations. It was alleged that a staff was coached from other staff to not say anything about the allegations because if the consumers get taken away, all staff will loose their jobs.
Interviewed staff denied the allegation. They stated that they never coached by other staff to not say anything about the allegations and didn't hear nor witnessed any staff coached others to not discuss any allegations. Interviewed Co Administrator stated that they always encourage the staff to be honest and tell the true about any issues at the facility. Clients interviewed cannot corroborate the allegation. They stated that they didn't have any information about any allegations at the facility.

In regards to the allegation: Facility has an insufficient food supply. It was alleged that there's not enough food in the home, one day there is the next few days it's empty.
Interviewed co administrator and staff denied the allegation. They stated that always have plenty of food in the facility. Co administrator and S2 stated they do grocery shopping every week and as needed (Receipts were provided). Clients always have enough food and they would follow the facility menu but they would also modify depends on how clients like the food on that day. During the visit LPA observed 2 days perishable and 7 days non-perishable food supply in the kitchen and in the storage which are sufficient and adequate.
Interviewed interpreter stated that there is always enough food at the facility. They were witnessed that facility staff do the grocery shopping every week. Interviewed clients stated that they like the food at the facility and there is always enough food for them. They can ask for second portion.

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NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250311170823

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: 03/20/2025

NARRATIVE

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In regards to the allegation: Staff are mismanaging client’s medications. It was alleged that staff has flushed medication in the toilet because they found the pills in bubble pack still and was not given/administrated to consumers/clients.
Interviewed staff denied the allegation. They stated that they didn't see or heard that administrator or other staff at the facility flushing medications in the toiled. They stated that staff administrated medications by physician's order and in a timely manner. If there are discontinued medications or medications for the clients who moved from the facility and didn't take medications with them, will be destroyed in a proper way. Interviewed co administrator stated that medications are destroyed by assigned staff and facility keeps record of destroyed medications. Interviewed S2 stated that they one of assigned staff to destroy the medications and they are following the procedure how destroy the medications. S2 stated that there are always 2 staff present and they keep the record at the facility (record was provided). They stored the medications in a disposal container / red box and disposed through the local hospitals or pharmacy. Interviewed clients indicated that they didn't missed any medications and receive them in a timely manner. Interviewed clients stated that they didn't see that any staff flush medications in the toilet. According to the medication reviewed and MAR during today's visit, LPA observed that the facility has properly disposed discontinued, expired medications and all medications are administrated as prescribed and in a timely manner.

Based on the file/record reviews, observations and interviews conducted with staff and client there was not enough supportive evidence to concur with the reported allegations.
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 allegations are Unsubstantiated.

Exit interview was conducted and the copy of this report was provided to S2.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC9099 (FAS) - (06/04)

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