198601561-9-26-2023-28-AS-RORN-CWGUVT-20231010155540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601561
Report Date: 09/26/2023
Date Signed: 09/26/2023 02:58:21 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
07/14/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230714143715

FACILITY NAME:	AMBIRIA HOMES I		FACILITY NUMBER:	198601561
ADMINISTRATOR:	CARMEN VARGAS		FACILITY TYPE:	735
ADDRESS:	6424 SHERMAN WAY		TELEPHONE:	(323) 771-6800
CITY:	BELL	STATE: CA	ZIP CODE:	90201
CAPACITY:	4	CENSUS: 3	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	House Manager Horace Evans		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff handled client in care in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman made a visit to the facility and was greeted by Direct Support Staff (DSP) Mary Bowleg and explained the reason for the visit.
Shortly thereafter House Manager Horace Evans arrived.
The purpose of the visit is a subsequent visit to deliver findings from the complaint dated 07/14/2023.
The initial visit was conducted on 07/21/2023 and included the following:
Staff and client roster were submitted.
LPA and House Manager observed facility video dated 07/14/2023 which included from 5:00 AM to 6:20 AM.
Interview was conducted with Client C1 at 9:20 AM who was unable to answer questions and limited in her responses.
Interviews were conducted with Staff S 1 at 10:00 AM, Staff S 2 at 10:15 AM and Staff S 3 at 10:40 AM.
File was reviewed for C 1 and various documents were submitted.
Interview was conducted with Regional Center Representative at 11:00 AM.
At today's visit from 1:45 PM to 2:15 PM Client's C 2 and C 3 were interviewed.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20230714143715

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: AMBIRIA HOMES I	FACILITY NUMBER: 198601561
	VISIT DATE: 09/26/2023

NARRATIVE

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In regards to the allegation Staff handled client in care in a rough manner, based on interviews conducted and information gathered LPA and House Manager on 07/21/2023 observed the facility video dated 07/14/2023 which included the hours 5:00 AM to 6:20 AM.
The video observed revealed that Client C 1 was on the ground in the street with cars going by.
One staff picked up from behind the head and 2 staff were lifting from the back of the legs carrying C1 away from the middle of the street and onto the sidewalk by the facility.
LPA from the video did not observe staff handling C 1 in a rough manner.
Interview with Regional Center Representative who stated that C 1 does scream and sometimes makes threats. She does alot of eloping and behaviors and the same thing happened previously when she had lived at home. Stated that she could be blunt and would say comments to counselors such as don't hit me.
Stated she has no concerns with the facility and they have done a good job with C 1.
Interviews with C2 and C3 who stated that staff do a good job.
Stated that staff has treated C 1 well and that staff treat all client's well.
Said that C1 gets aggressive with staff, but they are professional and know how to deal with everyone.
Interviews with staff who stated that C 1 had left the front entrance on her own when she saw staff's car pull up and thought it was her moms.
Stated that C1's mom was called to try and get her to come in the house, but she still had behaviors throwing herself down on the floor.
Said that staff were trying their best to help C1 who was in the middle of the street and the staff were doing no wrong doing.

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

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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