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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602585
Report Date: 09/28/2023
Date Signed: 09/28/2023 11:44:05 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
09/20/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230920092129
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE #5FACILITY NUMBER:
198602585
ADMINISTRATOR:LATONYA KINGFACILITY TYPE:
735
ADDRESS:2111 EAST GARVEY AVE NORTHTELEPHONE:
(626) 502-1424
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Licensee Jason PaggeeTIME COMPLETED:
12:01 PM
ALLEGATION(S):
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Staff inappropriately handled a resident while in care.
INVESTIGATION FINDINGS:
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On 9/28/2023 at 8:35 a.m., Licensing Programming Analyst (LPA) Jewel Baptiste conducted and unannounced complaint visit to the facility. Upon arrival LPA met with Staff #1 and explained the reason for the visit. Staff #1 called the Licensee Jason Piggee and LPA explained the reason for the visit.

During today’s visit LPA toured the facility with Staff # 2. LPA obtained resident roster, staff roster,and incident reports dated 9/18/2023, 9/27/2023. LPA interviewed: Licensee and a total of four (4) staff who shall be referred to as S1 through S4. LPA interviewed a total of 4 clients who shall be referred to as: C1 through C4. LPA interviewed C1 and C2 via phone. LPA also contacted west Covina Police Department to gather information.

Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
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-20230920092129
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: CENTER FOR BEHAVIORAL CHANGE #5
FACILITY NUMBER: 198602585
VISIT DATE: 09/28/2023
NARRATIVE
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The investigation reveals the following: Regarding " Staff inappropriately handled a resident while in care”. It is alleged that staff S3 grabbed C1 and poured water on the client. During the visit LPA interviewed the Licensee and confirmed that there was an incident between S3 and C1 but S3 denied the allegation. 4 out of 4 staff denied the allegation, stating they have never hit any of the clients, nor have they witnessed staff members physically harming the clients in care. 3 out of 4 clients denied the allegation, stating staff has never hit them and they have not witness staff hitting another client. 1 out of 4 clients stated S3 poured water on them after they provoked S3 the day before.

Based on LPA's interviews, investigation revealed: 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 with Jason Piggee and Mannie George and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2