198602288-4-25-2023-28-AS-RORN-CR9LJE-20230426084749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602288
Report Date: 04/25/2023
Date Signed: 04/25/2023 11:03:28 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/14/2023 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230214135702

FACILITY NAME:	BRIGHTSIDE RESIDENTIAL INC		FACILITY NUMBER:	198602288
ADMINISTRATOR:	DUKES, KIPCHOGE		FACILITY TYPE:	735
ADDRESS:	517 RICHBROOK DRIVE		TELEPHONE:	(909) 622-5603
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 4	DATE:	04/25/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Cortney Green		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Resident hit another resident while in care.

INVESTIGATION FINDINGS:

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This report supercedes the report dated 2/22/2023 to include additional information.
Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Staff Courtney Green and explained the reason for the visit.
The purpose of the visit is to investigate the above allegation.
At today's visit Resident and Staff Roster was submitted.
Special Incident Report (SIR) dated 02/13/2023 was submitted.
Review of files for Client C 1 and Client C 2 were done and Initial Program Plan (IPP), Physician's Report and Emergency ID Page were submitted for C 1 and C2.
Interviews were conducted with Client's C1- C4 from 8:05 AM to 9:10 AM.
Interviews were conducted with Staff S1 and S 2 from 9:15 AM to 9:50 AM.
In regards to the allegation Resident hit another resident while in care, based on interviews conducted and information gathered Client C 1 stated that he had cursed at Staff S 1 and was approaching S 1 to throw a punch when C 2 hit him. Stated that S 1 handled it well by telling them to calm down and they did.
Said that Staff are near them every single time and make things alot better.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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-20230214135702

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: BRIGHTSIDE RESIDENTIAL INC	FACILITY NUMBER: 198602288
	VISIT DATE: 04/25/2023

NARRATIVE

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Stated he is aggressive to staff and C 2 reacts.
Client C 2 stated he did protect staff when C 1 was going to punch staff. Said that staff responded well by separating them and calming the situation.
All 4 client's interviewed stated that staff are professional and will de-escalate problematic situations and that staff do a good job.
Interviews with Staff S1 who said C 1 cursed at him calling him the N word and was mad and charged him.
Stated C2 did punch C 1 on the side of the face.
S 1 calmed both clients down and had them shake hands.
911 was called and police came.
Interview with Staff S 2 who stated that both C1 and C 2 are together Monday- Friday and does programming classes with both.
Stated that they went fishing together last week and both were together at the animal shelter.
Stated they are with each other all week and not mean to each other. Will have random episodes when 1 gets upset.
Stated that staff will redirect and take walks and calm them down. They will always try and redirect before it gets too big.

Although the incident occurred, it was not due to a lack of supervision. Facility took appropriate measures and reported the incident as required and therefore, the allegation is unsubstantiated

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.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Glenn Trueman
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC9099 (FAS) - (06/04)

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