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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602585
Report Date: 08/19/2024
Date Signed: 08/19/2024 10:36:38 AM

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
08/08/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240808153652
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:
08/19/2024
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:NK Olatunji - House ManagerTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff do not ensure clients are spoken to in an appropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint investigation to deliver findings on the above allegation. LPA met with NK Olatunji and explained the purpose of the visit.

The investigation consisted of the following:
During the initial visit conducted on 8/13/24 LPA obtained copy of the staff roster, interviewed 3 staff and 4 residents.
On 8/16/23 LPA continued interview with Staff #1 (S1) and conducted 2 more staff interviews via phone.
During todays visit 8/19/24 LPA delivered findings.

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
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 3
Control Number 28-AS-20240808153652
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: 08/19/2024
NARRATIVE
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The Investigation Revealed the Following:
Allegation: Staff do not ensure clients are spoken to in an appropriate manner.
LPA interviewed 4 clients and 3 out of 4 clients confirmed the above allegation stating that S2 and S3 have spoken to them inappropriately on multiple occasions. Clients each stated that they feel verbally attacked on some of the smallest of things, for example S2 will (upon entering the facility for their shift) begin to verbally redirect clients without knowing what the situation is or confirming with other staff what is going on, S4 also confirmed this to be true during staff interview. Clients further stated that S2 and S3 raise their voice at them regularly and feel that they are too demanding in the way they speak to clients. LPA interviewed 5 staff and 3 out of 5 staff stated that they have either heard or seen staff raise their voice or be demanding towards the clients in care. Interview with S4 revealed that they observed S2 (upon arrival for shift) shout demands to C2 for no apparent reason. Interview with S1 and S3 revealed that S2 has been spoken to about the way they speak to the clients.

Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC9099-D.


Exit interview conducted and copy of report and appeal rights were provided to NK Olatunji.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240808153652
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: 08/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1)To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidence by:

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Licensee/Administrator to conduct a training covering Clients Personal Rights and proper staff etiquette when speaking to the clients in care, to ensure that clients are accorded dignity in their pesonal relationships with staff and other persons.
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Based on interviews and observation, the licensee did not comply with the section cited above as 3 clients and 3 staff confirmed the allegation during interviews, stating that they have either seen or heard Staff #2 and Staff #3 raise their voice at clients or shout demands at clents, this poses a potential health, safety or personal rights risk to persons in care.
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Training to be completed by POC due date and a copy of training materials and participant list with signatures to be provided to LPA via email by POC due date. tena.herrera@dss.ca.gov
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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: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3