198602128-10-5-2023-28-AS-RORN-CWGVBU-20231010161806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602128
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:29:10 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
09/28/2023 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230928142755

FACILITY NAME:	VOCATIONAL INNOVATIONS		FACILITY NUMBER:	198602128
ADMINISTRATOR:	PATEL, MANDAKINI		FACILITY TYPE:	775
ADDRESS:	1532 E SAN BERNARDINO B1-B5		TELEPHONE:	(909) 971-3280
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	60	CENSUS: 24	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Noe Rodriguez - Program Director		TIME COMPLETED:	11:43 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client sustained an unexplained injury while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegation. LPA met with Noe Rodriguez and explained the reason for the visit.

The investigation consisted of the following: On 10/04/2023, LPA interviewed Client 1 (C1) Regional Center Service Coordinator via phone and obtained C1's Individual Program Plan (IPP). During today's visit, LPA Mora obtained copies of staff and client rosters, C1's face sheet, C1's body check form, C1's T-Log notes, C1's special incident report, van seating arrangement and training logs. LPA interviewed Program Director, Staff 1 - Staff 3 (S1 - S3), and Client 2 - Client 5 (C1 - C5). C1 is no longer attending the this Adult Day Program (ADP).

The investigation revealed the following: regarding the allegation "client sustained an unexplained injury while in care”, it is alleged that the client returned home with bruises behind the left ear and this happened at the Adult Day Program (ADP). (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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 2

Control Number 28-AS-20230928142755

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: VOCATIONAL INNOVATIONS	FACILITY NUMBER: 198602128
	VISIT DATE: 10/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Program Director and staff denied the allegation. The staff that transported C1 to the ADP stated that they did not observed bruises when they picked up the client. They also stated there was no incidents during the drive to the ADP. Staff stated that at the ADP there was also no incidents that could have led to C1 sustaining the bruises. All staff stated that C1 has not displayed any self-injury behavior. S3 stated that around 11:40am he noticed 2 bruises on the back C1's left ear and the bruises were as big as a dime. S3 stated he was with C1 that day and nothing happened that could have led to the bruises. Clients interviewed could not corroborate the allegation. All clients stated that they have not observed staff hurting clients or clients hurting other clients. C2 was in the same van with C1 on the day of this allegation. C2 stated that nothing happened during the drive to the ADP and did not observed anything happening at the ADP.

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 held and a copy of the report was provided

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Luis Mora
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2