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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601949
Report Date: 04/16/2024
Date Signed: 04/16/2024 11:24:03 AM

Document Has Been Signed on 04/16/2024 11:24 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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:OPARC SUMMIT SERVICES WESTFACILITY NUMBER:
198601949
ADMINISTRATOR/
DIRECTOR:		TOMINES, JONATHANFACILITY TYPE:
775
ADDRESS:355 S LEMON AVE STE GTELEPHONE:
(909) 598-8055
CITY:WALNUTSTATE: CAZIP CODE:
91789
CAPACITY: 60CENSUS: 45DATE:
04/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Program Manager, Stephen FallaTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit due to an incident reported by the facility. LPA arrived and explained the purpose of the visit to the program manager, Stephen Falla.

On 4/9/24, LPA received an incident report from the facility indicating a Staff (S1) placed an elbow and ran it down Client #1’s (C1) back with force, which caused C1 to jerk forward. The incident took place on 4/8/24 at a park while C1 was trying to get in the vehicle.

During the visit today, LPA reviewed the client file and interviewed staff. LPA attempted to interview C1 but C1 did not respond to any questions. One of the staff interviewed witnessed S1 using force on C1’s back which caused C1 to jerk forward. There was no bruise observed on C1. S1 was also interviewed and stated he was trying to help C1 into the vehicle but denied using any force. According to the program manager, there were no previous write ups or verbal warnings on file. In addition, S1 has been terminated.

There are no deficiencies issued at this time. A copy of this report was provided to Mr. Falla.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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