198601740-10-18-2022-28-AS-MVAO-CL2UFS-20221110143314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601740
Report Date: 10/18/2022
Date Signed: 10/18/2022 02:23:37 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
10/10/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20221010165545

FACILITY NAME:	QUALITY OF LIFE ACADEMY		FACILITY NUMBER:	198601740
ADMINISTRATOR:	NNAEMEKA EZENAGU		FACILITY TYPE:	775
ADDRESS:	8439 CALIFORNIA AVENUE		TELEPHONE:	(562) 372-4750
CITY:	SOUTH GATE	STATE: CA	ZIP CODE:	90280
CAPACITY:	66	CENSUS: 40	DATE:	10/18/2022
		UNANNOUNCED	TIME BEGAN:	11:47 AM
MET WITH:	Director Joshua Corzantes		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff hit client while in care.

INVESTIGATION FINDINGS:

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On 10/18/22 at 11:47 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced
complaint to the facility. Upon arrival LPA met with Joshua Corzantes (Director) and explained the purpose of the
visit.

During today’s visit LPA toured the facility with director, obtained resident/ staff roster, Crisis Intervention Institute (CPI) training for S1 and S2, C1’s Individual Program Plan (IPP) and Special incident report (SIR) dated 10/12/22. LPA interviewed
clients C1 through C5. LPA Interviewed director, Staff S1, and S2.

Report continued on 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

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-20221010165545

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: QUALITY OF LIFE ACADEMY	FACILITY NUMBER: 198601740
	VISIT DATE: 10/18/2022

NARRATIVE

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The investigation reveals the following: Regarding "Staff hit client while in care", it is alleged that C1 was hit by facility staff at the day program. LPA reviewed C1’s IPP and observed C1 has a history of disruptive behaviors, aggressive social behaviors, destruction of property, running/wandering away, emotional outbursts and self-injurious behaviors. C1’s family member stated C1 is aggressive and tends to be attention seeking. They further stated that C1 will make up stories to get what C1 wants. Interview with director revealed that C1 has been receiving services from the program for 3-4 weeks. The director stated since C1 started they have witnessed C1 become verbally and physically aggressive to them self, staff and family members. The director stated the facility had to restrain C1 to keep C1 from hurting them self and others and has sent an SIR to Licensing. The director further stated that when C1 is not getting attention it will trigger an emotional outburst. 2/2 staff stated they have been attacked by C1 and try to clam C1 by using relaxation or writing techniques but using a CPI hold would be a last resort. 4/5 clients stated they like participating in the program and has never seen staff hit or abuse clients. 1/5 clients stated staff hit and abuse them, but they usually attack staff whenever staff get on their nerves. 1/5 clients further stated they don’t like being restrained, but do not want to leave the program. During the visit LPA observed C1 yelling out for S1.

Based on LPA's interviews, file review and observation investigation revealed: Although the allegation may have happened or is valid,there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Director Joshua Corzantes and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022

LIC9099 (FAS) - (06/04)

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