198600241-11-3-2022-28-AS-MVAO-CL2SSB-20221110130739

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198600241
Report Date: 08/15/2022
Date Signed: 11/03/2022 02:14:36 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
07/28/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220728094341

FACILITY NAME:	CHOICES R US - SPRY		FACILITY NUMBER:	198600241
ADMINISTRATOR:	BRADFORD, SHAJUANA		FACILITY TYPE:	735
ADDRESS:	9614 SPRY ST		TELEPHONE:	(562) 302-0348
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY:	6	CENSUS: 6	DATE:	08/15/2022
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Chavette Calhoun, House Manager		TIME COMPLETED:	10:08 AM

ALLEGATION(S):

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Staff do not adequately supervise resident's behavior

INVESTIGATION FINDINGS:

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****This is an amendment to the complaint investigation report that was delivered on 10/27/22. This amendment supersedes the original complaint investigation report and the finding remains the same. ****

The purpose of this Complaint Investigation report dated 8/15/22 is to provide an Amendment to the report 10/27/22 to remove confidential names and add administrator name to the report. The finding of the complaint investigation remains unchanged.

On 8/15/2022 at 8:50 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with S1 and explained the reason for the visit. Administrator Shajuana Bradford was not present during the visit.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

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-20220728094341

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 - SPRY	FACILITY NUMBER: 198600241
	VISIT DATE: 08/15/2022

NARRATIVE

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The initial complaint visit was conducted on 08/04/2022. During the visit LPA Baptiste toured the facility with the administrator and obtained the resident/ staff roster. LPA interviewed residents C2 through C5. LPA Interviewed the senior administrator, administrator, Staff S1 and S2. Copies of the following documents were obtained and reviewed in reference to C1: Identification and Emergency Information, IPP, functional and capabilities assessment, Appraisal/Needs and Services Plan, SIR dated 7/28/22. During today’s visit LPA interviewed C1 over the phone.

The investigation reveals the following: In regard to " Staff does not adequately supervise resident's behavior ". The details of this allegation state that Client #1 grabbed Client #2 by the arm, and swing, and throw C2 around. Client #1 also kicked Client #3 in the butt. LPA reviewed C1 functional and capability assessment revealed that C1 do not have a history of behaviors resulting in harm to self or others that require supervision. C1 IPP states that C1 do have aggressive behaviors but sees a behaviorist. Administrator stated C1 has never became physically aggressive with other clients but have become verbally aggressive. Staff has always redirected C1 in those situations. The facility investigated and 5/6 clients denied the altercation and 1/6 stated don’t remember the altercation. 2/2 staff stated never seen clients becoming physically aggressive at the facility. 1/5 clients confirmed being kicked by C1. 4/5 clients denied witnessing C1 becoming physically aggressive to other clients. 5/5 clients confirmed feeling safe at the facility.

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 unsubstantiated.

Exit interview held and a copy of the report was provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2022

LIC9099 (FAS) - (06/04)

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