<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602585
Report Date: 04/19/2024
Date Signed: 04/19/2024 03:41:09 PM

Substantiated


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
03/25/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240325095325
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:
04/19/2024
UNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:La Tonya King - Administrator
Nkechi Olatunji - House Manager		TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure facility policies are enforced.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent complaint visit to investigate the above allegations. LPA met with Administrator, Latonya King and House Manager, Nkechi Olatunji and explained the purpose of the visit.
During the initial visit conducted on 03/28/2024, LPA obtained copies of the Staff & Client rosters, C1's files such as Admission Agreement, Identification & Emergency Information, Physician's Report, latest IPP, Needs/Services Appraisal Plan and Medication Administration Records (MARs) for Feb-Mar 2024. LPA conducted a facility tour of the common areas including C1's room. LPA interviewed Staff #1 (S1) – Staff #3 (S3) and Client #1 (C1) - Client #4 (C4). LPA also requested copies of the Staff In-service training about Personal Rights, Clients Rights and Zero Tolerance Policy.
During today's visit, LPA obtained the staff & client rosters, copies of the house rules (old & new) and Staff In-service training about Personal Rights, Clients Rights and Zero Tolerance Policy. *****CONTINUED ON LIC9099-C*****
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
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 5
Control Number 28-AS-20240325095325
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: CENTER FOR BEHAVIORAL CHANGE #5
FACILITY NUMBER: 198602585
VISIT DATE: 04/19/2024
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
The investigation revealed the following:

In regards to allegation: "Staff do not ensure facility policies are enforced." It is alleged that staff allowed client to bring alcohol into the room to drink with the door locked to not get in trouble with the police when drinking outside. It is also alleged that the staff allowed this against the house rules of no drugs or alcohol in the facility. 3 out of 3 staff interviewed stated that when C1 comes home high and intoxicated, staff allowed C1 to bring alcohol inside the room to avoid him getting arrested by police if he gets caught drinking outside the facility. Staff indicated that they talked to C1 many times about drinking and his safety. C1 stated that staff has been allowing him to bring and drink alcohol inside the facility because it is his right and this is his home. C2-C4 confirmed that staff allowed C1 to bring in alcoholic beverages into the room and they have seen C1 with alcohol and drink alcohol inside the facility. LPA reviewed the house rules (effective until 03/26/2024) which stated that alcoholic beverages are not allowed on the property at any time. The house rule has been updated since and according to the Administrator, the new house rule took effect on 03/27/2024.

Based on LPA’s interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Deficiency cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to the Administrator, La Tonya King along with the Appeals Rights.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/25/2024 and conducted by Evaluator Bennette Pena
COMPLAINT CONTROL NUMBER: 28-AS-20240325095325

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:
04/19/2024
UNANNOUNCEDTIME BEGAN:
11:53 AM
MET WITH:La Tonya King - Administrator
Nkechi Olatunji - House Manager		TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident medication(s) unattended.
Staff withheld resident’s personal funds as punishment.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
In regards to the allegation: "Staff left resident medication(s) unattended." It is alleged that staff removed a client's medication from the package and left the medication on the counter in the kitchen for an unknown amount of time. Interviewed staff denied the allegation and stated that they never leave medications unattended. Staff stated that when they pass the medications to the client, they wait and make sure that the clients take their medications. 3 out of 4 clients interviewed stated that staff pass the medications to them and watch them take it. Interviewed clients stated that they have never seen any staff leave medication anywhere unattended. During the initial visit, LPA observed a staff passing the medication to a client and the staff watched the client took it. Therefore there was insufficient evidence to corroborate with the allegation.
*****CONTINUED LON LIC9099-C*****


Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20240325095325
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: CENTER FOR BEHAVIORAL CHANGE #5
FACILITY NUMBER: 198602585
VISIT DATE: 04/19/2024
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
In regards to the allegation: "Staff withheld resident’s personal funds as punishment." It is alleged that staff left the facility without giving the client the money from the personal funds on purpose because staff did not want the client to go out again since the client woke the staff up the night before. 3 of 3 staff interviewed denied the allegation. S1 stated that she took an urgent call and left in a hurry. But S1 asked another staff to give C1 the money for which the staff got reimbursed. Interviewed clients stated that they have no issues with receiving money from staff when they ask. Clients stated that money is given to them every 10th of each month or whenever they ask. LPA reviewed C1's cash resources list for March 2024 which showed cash out was given to C1. Therefore there was insufficient evidence to corroborate with the allegation.

Based on statements and interviews conducted with staff, clients, and review of facility file records, there was not enough supportive evidence to concur with the reported allegations. 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 allegations are UNSUBSTANTIATED.

Exit interview conducted and copy of report was provided to La Tonya King, Administrator.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20240325095325
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: CENTER FOR BEHAVIORAL CHANGE #5
FACILITY NUMBER: 198602585
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/24/2024
Section Cited
CCR
80022(a)
1
2
3
4
5
6
7
80022 Plan of Operation...(a) Each licensee shall have and maintain on file a current, written, definitive plan of operation.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
During the visit, Administrator provided a copy of the updated house rules which took effect on 03/27/2024. New house rules did not specify restrictions on bringing alcoholic beverages inside the facility. **Deficiency cleared.**
8
9
10
11
12
13
14
LPA's review of the old House Rules revealed that staff did not enforce and maintain the house rules for the protection of clients. House rule effective until 03/26/2024 stated that alcoholic beverages are not allowed on the property at any time.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5