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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601321
Report Date: 01/11/2024
Date Signed: 01/11/2024 11:56:47 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2023 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20230622115123
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA WEST 88TH ST HOMEFACILITY NUMBER:
198601321
ADMINISTRATOR:VELASQUEZ, VILMAFACILITY TYPE:
735
ADDRESS:6701 W 88TH STTELEPHONE:
(310) 649-5364
CITY:WESTCHESTERSTATE: CAZIP CODE:
90045
CAPACITY:4CENSUS: 3DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
11:44 AM
MET WITH:Edgar Arana/ AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility abandon resident.
INVESTIGATION FINDINGS:
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On 1/11/2024, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced visit to deliver findings of a complaint, LPA was greeted by Administrator Edgar Arana and the purpose of the visit was explain to him.
On 06/28/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced complaint visit at this facility, LPA was greeted by Staff Martha Sanchez the later by Administrator Edgar Arana. LPA explained the purpose of the visit is to investigate the allegation mentioned above.

The investigation consisted of: LPA conducted interviews with Administrator Edgar Ariana(A#1), Staff (#1), Staff (#2). LPA obtained and reviewed the following records: staff roster, facility emergency reporting protocols, client roster, C#1 and C#2 Physician Report (dated:11/7/2020), C#1 and C#2 Medication Administration Record June 2023, C#1 and C#2 Regional Center IPP (dated:11/17/2022), C#1and C#2 Pre-placement Appraisal Information (dated: 7/9/2012) C#1 and C#2 Emergency Identification Form (no date) and C#1 and C#2 Annual Behavior Assessment & Progress Review (dated: 12/27/2022).
(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 4
Control Number 11-AS-20230622115123
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA WEST 88TH ST HOME
FACILITY NUMBER: 198601321
VISIT DATE: 01/11/2024
NARRATIVE
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The investigation revealed the following:

It is alleged that the facility did not want the client back at the facility.

During records review, LPA reviewed C#1’s Needs and Service Plan, it stated that C#1 needs assistance with developing relationships with housemates and other individuals. LPA review LIC 602, In here is stated that C#1 is non-verbal. LPA also reviewed LIC 603, it is stated that C#1 has a history of self-injurious behavior as well as aggressive behavior towards others.


During an interview with the administrator (A#1), LPA found that on 6/20/2023, (C#1) had a behavioral episode that lasted for a few days. During this episode, (C#1) became physically aggressive towards a female staff. As a result, (A#1) called the paramedics to check on (C#1)’s health status and transported him to the hospital; when (C#1) arrived at the hospital, he had to be put on a chemical and physical restraint. (A#1) activated (C#1)’s crisis response project, and Board-Certified Behavior Analyst (S#2) was notified the day after. On 6/21/2021, the hospital ran tests on (C#1). The test results came back negative. In addition, (A#1) stated that DMH came that day and recommended that (C#1) be transferred to a psychiatric unit. Since the hospital did not have a psychiatric unit, (C#1) needed to be transported to another hospital. On the other hand, the ratio at the facility is two clients for one staff, (A#1) asked Westside Regional Center if it is possible to have 1 staff per 1 client to prevent future incidents. Currently, (C#1) is at another ARF for temporary respite. On 8/23/23 the facility and regional center had a meeting regarding (C#1), during this meeting both parties concluded that client will be returning to the facility, no date has been set for return. Facility requested to regional center to have (C#1) with 1:1 ratio and psychiatric follows up before returning to facility, this for health and safety reasons, and to best support (C#1) in being successful with his transition back home.

(Evaluation Report continues LIC 9099-C)
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230622115123
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA WEST 88TH ST HOME
FACILITY NUMBER: 198601321
VISIT DATE: 01/11/2024
NARRATIVE
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During interviews with staff (S#1) stated that no other clients had been abandoned at a hospital in the past.

During an interview with staff (S#2), said that she was notified of the incident on 6/21/2023. (S#2) is the BCBA for the Easter Seals of Southern California, and she provides consultation to the homes to create a behavior plan to follow when clients have behavioral episodes. (S#2) stated that no clients had been abandoned at the hospital in the past.

During interview with (W#1), she stated that (C#1) was having bad behaviors that facility took him to the ER. They were placed on a 5150 but, by the second day, they were ready to be released. Facility requested a psychiatric and medication review before (C#1) being released but did not occur. Facility did not feel safe for (C#1) to return to the facility, so Westside Regional Center placed them in a respite home. WRC and the facility are working together so (C#1) can return to their house. The plan for (C#1) to return to facility is the facility will hire a male staff and apply for Health and Safety Waiver. WRC has requested a medication review and we are connecting (C#1) with one of our psychiatrists that will follow him. I don’t feel facility abandoned him; I think facility couldn’t handle him at the time of his melt down. Facility did not feel safe having (C#1) around the other clients.

(Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20230622115123
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA WEST 88TH ST HOME
FACILITY NUMBER: 198601321
VISIT DATE: 01/11/2024
NARRATIVE
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On 12/19/23, Licensing Program Analyst-LPA Alfonso Iniguez received a phone call from Westside Regional Center QA Specialist (W#2) regarding (C#1) 's complaint investigation. LPA Iniguez asked (W#2) if they believed (C#1) 's home could offer the level of care (C#1) needs now. (W#2) stated no, (C#1) 's current home cannot provide higher care. In addition, (W#2) stated that (C#1) was put on respite for a temporary period until Westside Regional Center conducted research and found a new home for (C#1) that could provide the level of care they needed. LPA asked (W#2) if the home abandoned (C#1), (W#2) stated that “that’s not the case.



LPA was not able to interview (C#1) and other clients due to clients are not verbal and they are severely disable. However, Westside Regional Center is the responsible party for (C#1) and 3 more clients at the facility. LPA did spoke with WSRC.


During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.


California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Edgar Arana/Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4