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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600626
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:47:14 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
04/29/2022 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220429150133
FACILITY NAME:NEW BEGINNINGS ATCHINSONFACILITY NUMBER:
198600626
ADMINISTRATOR:JANICE COLLINSFACILITY TYPE:
735
ADDRESS:403 ATCHISON STREETTELEPHONE:
(626) 398-0911
CITY:PASADENASTATE: CAZIP CODE:
91104
CAPACITY:6CENSUS: 3DATE:
05/09/2022
UNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Margaret HarveyTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Lack of supervision resulting in resident leaving the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced 10 day complaint visit to this facility and met with Administrator Margaret Harvey to discuss the purpose for todays visit.

The investigation consisted of: Interviews with staff and other parties. LPA Wesley requested a copy of the staff roster, staff schedule, resident roster, incident reports, Pasadena police report dated 04/27/22, ID page, physician's reports, IPP and specific documents for client #1.

Regarding allegation: Lack of supervision resulting in resident leaving the facility. During the investigation it was revealed that client #1 receives 1:1 services funded by the Frank D. Lanterman Regional Center (FDLRC) through the Home Instead agency due to their behaviors. The investigation revealed that client #1 has eloped from the facility on several occassions with the most recent occurrence on 04/27/22 at 3:35pm, while

Continued on LIC 9099C.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 28-AS-20220429150133
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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
VISIT DATE: 05/09/2022
NARRATIVE
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the 1:1 caregiver was on site. Client #1 was later returned to the facility by the Pasadena Police Department. During the interview with the Administrator, LPA was informed that client #1 has recently began eloping more frequently as their routine has been compromised due to them not attending day program services within the last 2 years due to the pandemic. Administrator also advised that client #1 receives 1:1 services 7 days a week from 9am-5:30pm. Client #1 becomes bored easily and that the 1:1 agency does not provided the assistance necessary to prevent client #1 from eloping from the facility.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights given.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20220429150133
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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/23/2022
Section Cited
CCR
80078(a)
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The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirment has not been met as evidence by: Client #1 has eloped from the facility on several occassions, with
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The Administrator shall develop a plan to prevent client #1 from eloping. The Administrator shall also conduct an inservice training with all staff on AWOL/Eloping procedures(what to do and how to avoid them from occurring).
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the most recent occurrence on 04/27/22 while under the supervision of the 1:1 care provider which poses a health and safety concern for the clients in care.
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Please provide the Proof of corrections to CCLD/Attn Nicol Wesley by POC date 05/23/22.
Type B
05/11/2022
Section Cited
CCR
80061(b)(1)(E)
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Reporting Requirements
Upon the occurrence, during the operation of the facility, of any of the events specified in (1) below, a report shall be made to the licensing agency within the agency's next working day during its normal business hours......
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The Adminstrator will provide an unusual incident report(SIR) to CCLD/Attn: Nicol Wesley by POC date 05/11/22.
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Any unusual incident or client absence which threatens the physical or emotional health or safety of any client. This requirment has not been met as evidence by: The facility failed to report the incident when client #1 eloped on 04/27/22 which poses a health and safety risk to the clients in care.
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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: Nicol Wesley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3