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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602288
Report Date: 01/17/2023
Date Signed: 01/17/2023 03:47:40 PM

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
01/10/2023 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230110152804
FACILITY NAME:BRIGHTSIDE RESIDENTIAL INCFACILITY NUMBER:
198602288
ADMINISTRATOR:DUKES, KIPCHOGEFACILITY TYPE:
735
ADDRESS:517 RICHBROOK DRIVETELEPHONE:
(909) 622-5603
CITY:POMONASTATE: CAZIP CODE:
91767
CAPACITY:4CENSUS: 4DATE:
01/17/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Kip Dukes TIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Facility staff did not prevent residents from engaging in a physical altercation resulting in resident sustaining injuries
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint investigation to investigate above allegation(s) LPA met with administrator Kip Dukes and explaiend the reason of the visit and he also assisted LPA with the visit.

The investigation consisted of the following: On today's date, LPA interviewed the administrator, licensee, two staff (S1 and S2) via telephone and four clients (C1-C4) and obtained copy of client self-assessment for anger management, apology notes and think sheet and house meeting notes.

The investigation revelaed of the following: In regard to the allegation of "Facility staff did not prevent residents from engaging in a physical altercation resulting in resident sustaining injuries. LPA interviewed clients and reported the on duty staff did involve during the altercation and try to stop the fight. The staff did verbally redirect them and try to interfree but clients were very upset and could not listen and get into the fight. (See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
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-20230110152804
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: BRIGHTSIDE RESIDENTIAL INC
FACILITY NUMBER: 198602288
VISIT DATE: 01/17/2023
NARRATIVE
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LPA interviewed staff and denied the allegation and reported staff absolutely get interfered with the clients. The staff verbally redirected and separated them to stop hitting each other. Eventually it was successful stopping them. The staff reported in the beginning, both clients were very upset and happened so fast and clients already hit each other before calling the administrator or the corps. At one point, one staff were even in between them and tried to stop the fight.

Based on the interviews between staff and clients, Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with the Facility Administrator Kip Dukes. A copy of the report and Appeal Rights were provided
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2