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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600626
Report Date: 08/28/2023
Date Signed: 08/28/2023 04:03:37 PM

Substantiated


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
08/22/2023 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230822161612
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: 4DATE:
08/28/2023
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Margaret HarveyTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not provide a client access to the home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 08/28/23 regarding the above allegations. LPA Ramirez was met by Administrator Margaret Harvey and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster (LIC 500), Resident Roster (LIC 9020), Staff #1 - 4 interviews(S1 – S4), Client #1 – 2 interviews (C1 – C2), copies of Client #1 (C1): 30 Day Individual Program Plan (IPP) dated 3/13/23, Intensive Behavior Support Assessment Record dated 12/30/22, Daily Behavior Technician Note dated 8/23/2023, Pasadena Police Dept CAD Call CP# PA-2023-70061, and physical plant tour.

See 9099-C for continuation.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
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-20230822161612
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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
VISIT DATE: 08/28/2023
NARRATIVE
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The investigation revealed the following. Regarding Allegation: Staff did not provide client access to the home- It is alleged that facility staff locked C1 out of the facility on or around 8/23/23. Two (2) out of the four (4) staff interviewed deny this allegation. One (1) out of two (2) clients interviewed deny this allegation. LPA Ramirez reviewed C1’s file. C1 was admitted into the facility on 01-20-23. C1 has a history of physical aggression and damaging property. LPA Ramirez reviewed Daily Behavior Technician Note dated 8/23/23 from C1’ 1:1, which revealed C1’s 1:1 and S2 locked C1 out of the facility while C1 was having a behavioral episode. Based on C1’s Intensive Behavior Support Assessment Record dated 12/30/22, C1 has specific redirects for physical aggression behaviors. LPA Ramirez did not find documentation or interviews that staff utilized those redirects during this behavioral episode. Based on interviews, observations and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency is being cited. Exit interview was held with staff #4 (S4). A copy of this report, 9099-D and appeals rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20230822161612
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: NEW BEGINNINGS ATCHINSON
FACILITY NUMBER: 198600626
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2023
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

This requirement was not met as evidence by:
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 Licensee will certify plan on how the facility plans to address concerns with 1:1 staff following C1's Intensive Behavior Support Assessment Record and IPP. Licensee will provide update to C1's IPP on behaviors by 9/11/23 via email.
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(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Facility staff withheld shelter to C1 by locking C1 out of the facility during a behavioral episode. Facility staff did not follow C1's Intensive Behavior Support Assessment Record dated 12/2022, when C1's is engaging in physical aggressive behavior.

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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: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3