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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602128
Report Date: 05/29/2025
Date Signed: 05/29/2025 11:05:06 AM

Unsubstantiated


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
05/21/2025 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250521091522
FACILITY NAME:VOCATIONAL INNOVATIONSFACILITY NUMBER:
198602128
ADMINISTRATOR:PATEL, MANDAKINIFACILITY TYPE:
775
ADDRESS:1532 E SAN BERNARDINO B1-B5TELEPHONE:
(909) 971-3280
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:60CENSUS: DATE:
05/29/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Noe RodriguezTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not provide adequate supervision to client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Elizabeth Irra and Blanca Gonzalez conducted the initial visit to investigate the above allegation. LPA met with Noe Rodriguez and discussed the purpose of today’s visit.

During this visit, LPA obtained a copy of the staff and client rosters, reviewed C-1’s file and obtained relevant documentation, interviewed C-1, interviewed Staff #1 (S-1) through Staff #4 (S-4) and interviewed the Quality Assurance Representative from San Gabriel Pomona Regional Center.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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 2
Control Number 28-AS-20250521091522
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: VOCATIONAL INNOVATIONS
FACILITY NUMBER: 198602128
VISIT DATE: 05/29/2025
NARRATIVE
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Allegation: Staff did not provide adequate supervision to client in care. It has been alleged that on 05/16/25, C-1 had ingested (2) serving packets of Extra Strength Tylenol under the supervision of the Day Program staff. Staff interviews revealed that on 05/16/25, after community outings, C-1 informed staff that C-1 was not feeling well and requested to be given Tylenol (C-1 has a physician’s order on file). Per staff interviews, day program staff, contacted C-1’s residence to inquire if C-1 had been given Tylenol prior to administering the medication to C-1 at day program. Per staff interviews, during this process, C-1 then reported having tightness on their chest and as a result, day program staff called 911 and had C-1 transported to the Emergency Room. Per staff interviews, at the Emergency Room, C-1 informed S-4 that C-1 had taken (6) Tylenol pills prior to coming to day program. S-4 then reported this information to the hospital nurse and day program management. Day program submitted a special incident report to Community Care Licensing (CCL) pertaining to this incident. Per staff interviews, during day program, C-1 receives 1:1 supervision at all times. Per staff interviews, C-1 has a history of fabricating stories and recanting. Per Quality Assurance representative interview, C-1 has changed their story “multiple times” and their findings will most likely be “inconclusive”. Interviews do not corroborate this 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.

Exit interview conducted, a copy of the report and appeal rights was provided to Noe Rodriguez.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2