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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602585
Report Date: 04/14/2025
Date Signed: 04/14/2025 02:39:16 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
01/22/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250122170444
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:
04/14/2025
UNANNOUNCEDTIME BEGAN:
02:08 PM
MET WITH:Murielle Koyagialo, DSPTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff did not prevent client from having a sexually inappropriate interaction with another client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted an unannounced subsequent 10-day complaint visit at the facility and met with S4 to discuss the purpose for today's visit. The purpose of the visit is to investigate the above allegation.

On 01/30/2025, the initial investigation visit was conducted. The investigation consisted of the following:

LPAs interviewed the Administrator, Staff #1 (S1) and Staff #2 (S2). LPAs also interviewed Client #2 (C2) and Client #3 (C3). LPAs obtained copies from Client #1 (C1) file such as Physician's Report, Face Sheet, IPP (Individual Program Plan), Client Notes, Medication List, and Special Incident Reports. LPAs also obtained the staff and client rosters.

On 03/06/2025, LPAs interviewed C1, Client #4, Staff #3 (S3), and Witness #1 (W1) over the phone.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
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-20250122170444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CENTER FOR BEHAVIORAL CHANGE #5
FACILITY NUMBER: 198602585
VISIT DATE: 04/14/2025
NARRATIVE
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During today's visit, LPAs obtained the following documents: staff and client rosters.

The investigation revealed the following: in regards to the allegation " Staff did not prevent client from having a sexually inappropriate interaction with another client in care.” It is alleged that C1 knocked on C2’s bedroom door while C2 was laying in bed and C2 allowed C1 to enter. C1 walked to the bed putting C1 on top of C2 and began thrusting C2 and C2 was uncomfortable and C2 told C1 not to do that anymore. LPAs interviewed Admin, S1 and S3 and all corroborated with the allegation. All staff interviewed stated that the incident occurred and that C1 has had incidents of inappropriately touching that cause clients and staff to feel uncomfortable. One of the staff interviewed witnessed C1 inappropriately touching another client in the private area. The staff interviewed also stated that C1 continues to caress the staff’s hand whenever medication is administered to C1. One of staff also stated feeling uncomfortable when C1 tries to hug every staff whenever the staff leaves the home. Two (2) out of four (4) clients interviewed corroborated with the allegation. One (1) out of four (4) clients stated that there have been prior incidents of C1 inappropriately touching another client. These clients indicated feeling uncomfortable by C1’s inappropriate and unwanted touching. One of the clients stated being touched in their behind and legs area by C1 and told C1 to stop doing that. Two (2) out of four (4) clients interviewed denied the allegation. C1 stated that C1 only handshakes or high fives the clients and staff.

W1 also corroborated with the allegation and stated that C1 has behaviors of touching inappropriately other persons so C1 has been encouraged to attend a program to help educate in appropriate communication and social interactions.

Based on LPAs interviews which were conducted interviews and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

An exit interview was conducted with the S4. A copy of the report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250122170444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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: 04/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
04/15/2025
Section Cited
CCR
80072(a)(1)
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(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 evidenced by:
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Administrator to ensure that clients are accorded personal rights at all times. Licensee/Administrator to train staff on
client personal rights and personal boundaries. Administrator to submit training plan by POC due date and submit
training materials and list of staff that attend the training once training has been completed.
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Based on record review and interview, the facility staff did not prevent client of having a sexual inappropriate interaction with another client in care which poses an immediate health, safety, or personal rights risk to persons in care.
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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: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2025
LIC9099 (FAS) - (06/04)
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