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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601716
Report Date: 02/25/2025
Date Signed: 02/25/2025 11:31:09 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
02/21/2025 and conducted by Evaluator Erik Zaragoza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250221103259
FACILITY NAME:CHOICES R US - MIGUELFACILITY NUMBER:
198601716
ADMINISTRATOR:CARDENAS, GILBERTFACILITY TYPE:
735
ADDRESS:3951 MIGUEL AVETELEPHONE:
(562) 801-3061
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:4CENSUS: 3DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
11:11 AM
MET WITH:Marilyn Carillo - DSPTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff did not follow proper reporting requirements
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erik Zaragoza conducted an unannounced initial complaint visit to investigate the allegation listed above. LPA met with Marilyn Carillo, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Gilbert Cardenas was notified of the visit by the phone.

The investigation consistsed of the following: LPA obtained copies of the staff and resident roster, obtained in-service training staff received on incident reporting, and interviewed Staff #1 - 3 (S1 - S3). Prior to the visit LPA reviewed Serious Incident Reports (SIRs) from the date of 6/1/2024 - 2/24/2025, and also a Corrective Action Plan (CAP) from dated 2/19/2025 from the East Los Angeles Regional Center (ELARC).
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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-20250221103259
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: CHOICES R US - MIGUEL
FACILITY NUMBER: 198601716
VISIT DATE: 02/25/2025
NARRATIVE
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The investigation revealed the following: In regards to the allegation "Staff did not follow proper reporting requirements," based on the ELARC CAP there was an incident that occurred on 6/15/2024 between S2 and a former client who lived at the facility, Client #1 (C1), in which C1 was injured. It was alleged in the CAP that S2 did not report this incident to the administrator of the facility to the home administrator. During interviews with the staff members, none of them corroborated the allegation. One of the staff members interviewed stated that they did submit a written report of the incident to both ELARC and Community Care Licensing Division (CCLD) after they were made aware of the incident on 6/17/2024, and furthermore that the facility conducted an in-service training amongst staff on the subject of reportable incidents. S2 stated that they did report it to the administrator verbally who subsequently submitted the written report to ELARC and CCLD. During review of SIRs received by CCLD, it was revealed that a faxed incident report was submitted on 6/18/2024, which falls within the requirement of submitting an incident report within seven (7) days.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. 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.

Exit interview held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2