198601716-9-27-2024-28-AS-DSIS-D9UVTR-20241008164333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601716
Report Date: 09/27/2024
Date Signed: 09/27/2024 10:18:11 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
06/18/2024 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240618110757

FACILITY NAME:	CHOICES R US - MIGUEL		FACILITY NUMBER:	198601716
ADMINISTRATOR:	CARDENAS, GILBERT		FACILITY TYPE:	735
ADDRESS:	3951 MIGUEL AVE		TELEPHONE:	(562) 801-3061
CITY:	PICO RIVERA	STATE: CA	ZIP CODE:	90660
CAPACITY:	4	CENSUS: 3	DATE:	09/27/2024
		UNANNOUNCED	TIME BEGAN:	08:22 AM
MET WITH:	Isidro Serrano		TIME COMPLETED:	10:32 AM

ALLEGATION(S):

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Staff hit resident resulting in injuries

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent complaint visit to address the allegation listed above. LPA met with Isidro Serrano, Direct Support Staff (DSP) for the facility, and explained the purpose of the visit. Administrator Gilbert Cardenas was notified of the visit by phone call.

The investigation consisted of the following: During the initial visit conducted on 6/19/2024, LPA conducted a tour of the facility and interviewed Clients #1 - 4 (C1 - C4), Staff #1 - 3 (S1 - S3). LPA also request that administrator Gilbert Cardenas email LPA the Physician's Report, Appraisal, and FACE Sheet from Client #1 (C1), along with the current staff and client rosters. Since the initial visit and during this subsequent visit, LPA interviewed Staff #4 (S4), Witness #1 (W1) and obtained the Individual Program Plan (IPP), Physician's Report, FACE Sheet, Facility Behaviorist Report, Hospital Discharge Paperwork, and documentation from C1's Orthopedic Specialist related to a visit that C1 had with them.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Erik Zaragoza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

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-20240618110757

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: 09/27/2024

NARRATIVE

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The investigation revealed the following: In regards to the allegation that "Staff hit resident resulting in injuries," it is alleged that C1 was hit by a staff member who works at the facility which caused them to sustain extreme bruising on chest and right armpit. During interviews with the clients, zero (0) out of four (4) interviewed corroborated the allegation that C1 was hit by any staff member at the facility. During an interview with C1, they claimed that they fell at the facility which caused their injury. Other clients interviewed stated that they have never seen any staff member hit anyone in the facility. During interviews with the staff, zero (0) out of four (4) corroborated the allegation that any staff member hit C1 in the facility. During the course of the investigation, it was revealed through interviews with S1 and W1 that the injury was the result of an interaction between C1 and S4. Furthermore, it was also revealed through hospital discharge paperwork and documentation from C1's orthopedic specialist that C1 suffered a broken right clavicle as a result of this altercation. During an interview with S4, on the date of the incident they went to C1's room and upon greeting C1, they can observe that C1 was upset. S4 stated that C1 ultimately lunged at them in an attempt to push and hit S4, and S4 stated that they extended their arms outwards in order to create distance between them. S4 stated that C1 lunged into their outstretched arms so forcefully that this caused C1 to fall backwards and onto a night stand drawer in their room. S4 stated that C1 falling onto their drawer ultimately caused the injury, and that they did not intentionally hit or push C1 to cause the injury.

LPA determined based on the evidence that this injury was not the result of staff intentionally hitting C1, and therefore the allegation will be unsubstantiated. However due to the Serious Bodily Injury that C1 sustained along with the fact that Emergency intervention procedures outlines in the Facility Behaviorist Report plan for C1 were not followed during this incident, a separate citation will be issued on a case management in relation to this complaint investigation.

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: 09/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024

LIC9099 (FAS) - (06/04)

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