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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198600751
Report Date: 04/24/2025
Date Signed: 04/24/2025 09:34:00 AM

Unsubstantiated


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
03/11/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250311084758
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE IFACILITY NUMBER:
198600751
ADMINISTRATOR:JASON A PIGGEEFACILITY TYPE:
735
ADDRESS:604 E MCKINLEY AVETELEPHONE:
(909) 865-2354
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:6CENSUS: 6DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Carla Pumphrey/S-1 TIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Personal Rights: Staff engaged in a physical altercation with a client resulting in an injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit investigate the above allegation. LPA met with Carla Pumphrey/S-1 and discussed the purpose of today's visit. Ms. King arrived at approximately 9:25 A.M..

LPA Irra conducted the initial visit on 03/12/25. During this visit, LPA conducted a tour of the building and grounds and did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA also reviewed Client #1 (C-1) files and obtained relevant documentation. Additionally, LPA obtained a copy of the staff schedule and client roster.

During the course of this investigation, LPA interviewed Staff #1 through Staff #6 (S-1 through S-6) and interviewed Client #1 (C-1), Client #4 (C-4) and Client #5 (C-5). LPA was unable to interview Client #2 (C-2) and Client #3 (C-3) as both are non-verbal. LPA attempted to interview Client #6 (C-6) and was unsuccessful. LPA also made numerous attempts to interview the Quality Assurance representative from San Gabriel Pomona Regional Center and was unsuccessful. *Refer to LIC 9099C for the continuation of this report.*
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 2
Control Number 28-AS-20250311084758
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: CENTER FOR BEHAVIORAL CHANGE I
FACILITY NUMBER: 198600751
VISIT DATE: 04/24/2025
NARRATIVE
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Allegation: Staff engaged in a physical altercation with a client resulting in an injury. (2) out of (3) interviewed staff (present during the 03/06/25 alleged incident) indicated they did not witness S-4 hitting C-1. Staff interviews revealed that C-1 was hitting S-4 for unknown reasons and that S-4 was trying to de-escalate C-1. Interviewed staff indicated that S-4 yelled for staff to call 911 due to C-1 hitting S-4. S-4 indicated that when C-1 came after S-4 and continued to hit S-4, S-4 had to hold C-1 as trained during CPI training. Interviewed staff indicated they did not observe any injuries on C-1 the day of the incident. Interviewed staff indicated that the Police Department arrived, de-escalated C-1 and left this facility without opening a case (as C-1 remained calmed). Interviewed staff indicated that C-1 has a history of fabricating stories. Interviewed staff indicated they have not witnessed nor received any reports of staff (including S-4) hitting clients. Interviewed staff indicated they are trained in mandated reporting, zero tolerance, clients rights and nonviolent crisis intervention (CPI). (2) out of (3) interviewed clients revealed that they did not witness S-4 hitting C-1. (2) out of (3) interviewed clients revealed that staff (including S-4) do not hit clients. Interviewed clients indicated they feel safe residing at this home and do not have any concerns. Interviews do not corroborate this allegation.

Although the allegation may have happened or are 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 conducted, appeal rights and a copy of this report was provided to Ms. King.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2