198601740-4-12-2023-28-AS-BPEA-CQTQ26-20230412114637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601740
Report Date: 01/13/2023
Date Signed: 04/12/2023 11:46:37 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
01/09/2023 and conducted by Evaluator Bennette Pena

COMPLAINT CONTROL NUMBER: 28-AS-20230109142321

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: 43	DATE:	01/13/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Program Manager, Evelyn Prado		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff physically assaulted client while in care.

INVESTIGATION FINDINGS:

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*****This report dated 01/13/2023 is being amended to remove confidential information. Investigation findings on this report remain the same.******

Licensing Program Analyst (LPA) Bennette Pena conducted an initial complaint investigation for the allegation listed above. LPA met with Program Manager, Evelyn Prado and explained the reason for the visit.

The investigation consisted of the following: LPA Pena conducted a tour of the facility and common areas. LPA also reviewed Client #1 (C1) files and obtained copies of various documents from the files, interviews were conducted with staff and clients.

ALLEGATION: Staff physically assaulted a client causing injury. It is alleged that C1 was assaulted by staff members at the adult day care program, no exact date given as to when the incident happened. It is also alleged that no police report has been filed and C1 continues to attend the day care program.

***Continued on 9099C.***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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-20230109142321

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: QUALITY OF LIFE ACADEMY	FACILITY NUMBER: 198601740
	VISIT DATE: 01/13/2023

NARRATIVE

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*****This report dated 01/13/2023 is being amended to remove confidential information. Investigation findings on this report remain the same.******

The investigation revealed that the staff (S1-S4) interviewed denied any knowledge of the incident happening at the day care program. S1-S2 did not find any incident report of abuse, or injuries on file to C1 for 10/06/2022 as alleged. All staff interviewed denied that the staff had physically assaulted C1 or any clients. All staff stated that C1 has a history of making up stories and attention seeking. Interviews with C2-C4 revealed that they never witnessed any staff physically assaulting clients. All clients interviewed stated that they never saw any physical altercation causing injuries between staff and clients. Based on interviews conducted with staff and clients, LPA's review of C1's files and incident reports, there was no evidence to the allegation of physical abuse to C1. C1 suffers from Self-Injurious Behaviors (SIB) which is well documented by the facility. On these dates 10/11/2022, 10/17/2022 and 12/16/2022, C1 had a behavioral episode of SIB, which required verbal redirection and de-escalation from the staff. Therefore there was insufficient evidence to corroborate with the allegation.

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.

An exit interview was held, and a copy of the report was provided to the Program Manager, Evelyn Prado.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC9099 (FAS) - (06/04)

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