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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601740
Report Date: 11/20/2025
Date Signed: 11/20/2025 11:24:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
02/27/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250227151007
FACILITY NAME:QUALITY OF LIFE ACADEMYFACILITY NUMBER:
198601740
ADMINISTRATOR:NNAEMEKA EZENAGUFACILITY TYPE:
775
ADDRESS:8439 CALIFORNIA AVENUETELEPHONE:
(562) 372-4750
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:66CENSUS: 54DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Ezinne Okereke, Executive DirectorTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff had a physical altercation with client resulting in a fall/hospitalization
Staff did not seek timely medical care for client
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted a subsequent complaint visit in response to the above-mentioned allegations. LPAs met with Ezinne Okereke, Executive Director and explained the reason for the visit.

On 03/04/2025, the initial investigation visit was conducted. The investigation consisted of the following:

Investigation consisted of the following: LPA requested a copy of staff and client rosters. LPA conducted a tour of facility and common areas with the Program Director. LPA also requested copies from Client #1 (C1) file such as: Client Developmental Evaluation Report (CDER). LPA also requested copies of the Staff #1 (S1) file such as: Identification Card, Criminal Background Clearance, Documented Corrective Action, valid CPI training, valid First Aid/CPR/AED training, Ongoing staff training, Zero Tolerance for Consumer Abuse Policy form,
[Continue in LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
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 6
Control Number 28-AS-20250227151007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
VISIT DATE: 11/20/2025
NARRATIVE
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SOC341A Statement Acknowledgement Requirement to Report Suspected Abuse of Dependent Adults and Elders, Direct Support Staff Job Description, Confidentiality Agreement signed, Quality of Life Academy Whistleblower Policy, and Acknowledgement of Receipt of Employee Handbook. LPA observed the clients to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns.

During today's visit, LPAs obtained the following documents: staff and client rosters. LPAs also obtained staff training and other pertinent documents. LPAs interviewed the Executive Director.

The investigation revealed the following: in regard to the allegation, “Staff had a physical altercation with client resulting in a fall/hospitalization” It is alleged that on 02/24/2025 at approximately 1:30pm, S1 got in a struggle with the C1 resulting in C1 fall over a handicap railing falling on the floor requiring surgery for subluxation in C1’s neck. This allegation was investigated by the Investigation Bureau (IB) and was assigned to Investigator Miles. LPAs reviewed IB interviews which revealed the following: On 02/24/2025, the day of the incident, C1 had a behavioral episode. While running up the handicap rail, C1 was stopped by S1, where there was a physical struggle between the two. According to staff member(s) and written statement(s), S1 pushed C1 over the handicap rail resulting C1 going over the handicap rail and was unable to recover from the push. C1’s responsible party was contacted and instructed facility staff to call 911. 911 and emergency medical transport (EMT) responded, where C1 was transported to the ER. Upon arrival, C1 was diagnosed with a severe subluxation of the C4-C5 (broken neck). Based on the interviews conducted and supporting documentations, there is sufficient evidence that S1 pushed C1 over the handicap rails causing C1 to sustain a subluxation injury; therefore, the allegation of Physical Abuse is substantiated. There is enough evidence to substantiate.

Allegation: “Staff did not seek timely medical care for client” It is alleged that on 02/24/2025 at approximately 1:30pm, S1 got in a struggle with C1 resulting in C1 falling over a handicap railing falling on the floor and the Program Director contacted at 2:40pm. Paramedics arrived and transferred C1 to the ER. It is alleged that there was a delay in timely medical care for C1 after the incident occurred. This allegation was investigated by the Investigation Bureau (IB) and was assigned to Investigator Miles. LPAs reviewed IB interviews which revealed the following: On 02/24/2025, at approximately 1000 hours, the day of the incident, C1 had a behavioral episode.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20250227151007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
VISIT DATE: 11/20/2025
NARRATIVE
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While running up the handicap rail, C1 was stopped by TS1, where there was a physical struggle between the two. According to staff member(s) and written statement(s), S1 pushed C1 over the handicap rails resulting in C1 going over the handicap rail and was unable to recover from the push. It was not until after 1441 hours, C1’s responsible party was contacted who instructed facility to contact 911. During the timeframe between 1000 hours and 1441 hours, staff members attempted to assist C1 to get up multiple times, however C1 was unable to walk and/or get up from the ground even with the attempts of C1’s response to behavioral stimulation, such as food and water. When 911 and emergency medical transport responded, C1 was transported to the ER. At 1540 hours, upon arrival in ER, C1 was diagnosed with a severe subluxation of the C4-C5 (broken neck). Based on the interviews conducted, there is sufficient evidence that the facility failed to seek medical attention in a timely manner; therefore, the allegation of Neglect/Lack of Care and Supervision is substantiated. There is enough evidence to substantiate.

Based on LPA's interviews conducted with the residents and staff, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099D.



Immediate $500 Civil Penalty is being issued during today’s visit due to facility staff causing serious injury to client while in care. The Licensee was informed that an additional civil penalty may be assessed at a later date based on Health & Safety Code 1548(B)(ii).

An exit interview was held with the Executive Director, Ezinne Okereke and a copy of this report and appeal rights were provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20250227151007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/21/2025
Section Cited
CCR
82072(a)(3)
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(a) Each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to:

This requirement is not met as evidenced by:
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Executive Director is to ensure that all residents are free from corporal or unusual punishment at all times and re-train staff on personal rights and send training materials and training signup sheet to the LPA by POC due date.
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Based on interviews and records review, the licensee did not comply with the section cited above as facility staff caused serious injury to client while in care. This poses an immediate health, safety or personal rights risk to persons in care.
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Type A
11/21/2025
Section Cited
CCR
92075(a)
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(a)The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.

This requirement is not met as evidenced by:
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Licensee will ensure that the facility staff respond to medical personnel in a timely manner whenever a client is injured. Licensee will retrain staff and will submit training materials and sign in sheets discussed by the POC due date.
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Based on interviews and records review, the licensee did not comply with the section cited above as facility staff did not seek medical care in a timely manner in which the facility did not contact medical personnel until 2:41pm for C1 when the incident occurred at 10am, which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
02/27/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250227151007

FACILITY NAME:QUALITY OF LIFE ACADEMYFACILITY NUMBER:
198601740
ADMINISTRATOR:NNAEMEKA EZENAGUFACILITY TYPE:
775
ADDRESS:8439 CALIFORNIA AVENUETELEPHONE:
(562) 372-4750
CITY:SOUTH GATESTATE: CAZIP CODE:
90280
CAPACITY:66CENSUS: 54DATE:
11/20/2025
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Ezinne Okereke, Executive DirectorTIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
4
5
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9
Staff failed to notify clients responsible party of clients injury
Staff failed to notify clients placement agency of clients injury
INVESTIGATION FINDINGS:
1
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3
4
5
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7
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10
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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted a subsequent complaint visit in response to the above-mentioned allegations. LPAs met with Ezinne Okereke, Executive Director and explained the reason for the visit.

On 03/04/2025, the initial investigation visit was conducted. The investigation consisted of the following:

Investigation consisted of the following: LPA requested a copy of staff and client rosters. LPA conducted a tour of facility and common areas with the Program Director. LPA also requested copies from Client #1 (C1) file such as: Client Developmental Evaluation Report (CDER). LPA also requested copies of the Staff #1 (S1) file such as: Identification Card, Criminal Background Clearance, Documented Corrective Action, valid CPI training, valid First Aid/CPR/AED training, Ongoing staff training, Zero Tolerance for Consumer Abuse Policy form,
[Continue in LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20250227151007
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: QUALITY OF LIFE ACADEMY
FACILITY NUMBER: 198601740
VISIT DATE: 11/20/2025
NARRATIVE
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SOC341A Statement Acknowledgement Requirement to Report Suspected Abuse of Dependent Adults and Elders, Direct Support Staff Job Description, Confidentiality Agreement signed, Quality of Life Academy Whistleblower Policy, and Acknowledgement of Receipt of Employee Handbook. LPA observed the clients to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns.

During today's visit, LPAs obtained the following documents: staff and client rosters. LPAs also obtained staff training and other pertinent documents. LPAs interviewed the Executive Director.

The investigation revealed the following: in regard to the allegation, ”Staff failed to notify clients responsible party of clients injury” and “Staff failed to notify clients placement agency of clients injury” It is alleged that the facility did not notify C1’s responsible party and C1’s placement agency of C1’s injury within 24 hours. LPAs interviewed the Executive Director, Ezinne Okereke that denied the allegation by stating that the facility notified C1’s responsible party on the day of the incident and notified C1’s placement agency on 02/26/2025. LPAs observed record review the Program Director sent the Special Incident Report (SIR) regarding the 02/24/2025 incident to the Westside Regional Center on 02/26/2025. Additionally, there is no Regulation in Title 22 that indicates that the client’s placement agency needs to be notified within 24 hours of an incident occurring. LPAs also observed that the Program Director contacted C1’s responsible party on the day of the incident. Furthermore, it was confirmed that the C1’s responsible party was at the facility on the day of the incident. Facility acted in compliance by notifying both C1’s responsible party and clients placement agency. There is not enough evidence to substantiate.

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 is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.



An exit interview was held and a copy of this report was provided to the Ezinne Okereke, Executive Director.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6