198603011-9-27-2022-11-AS-MVAO-CQJUXU-20230403155854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603011
Report Date: 09/27/2022
Date Signed: 09/27/2022 05:23:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2022 and conducted by Evaluator Martessa Brown

COMPLAINT CONTROL NUMBER: 11-AS-20220919153055

FACILITY NAME:	INTEGRATED TREATMENT SERVICES III		FACILITY NUMBER:	198603011
ADMINISTRATOR:	AUBRI GRIFFIS		FACILITY TYPE:	737
ADDRESS:	15331 S AINSWORTH ST		TELEPHONE:	(310) 916-7200
CITY:	GARDENA	STATE: CA	ZIP CODE:	90247
CAPACITY:	3	CENSUS: 3	DATE:	09/27/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Raemie Hernandez-House Manager		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Multiple staff hit resident in care.

INVESTIGATION FINDINGS:

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On 9/27/22, Licensing Program Analyst (LPA) Martessa Brown conducted an unannounced complaint visit at this facility. LPA conducted risk assessment before entering the building and LPA observed Covid-19 Protocol. LPA met with Raemie Hernandez House manager and explained the purpose of today's visit was to investigate the above allegation.

The investigation consisted of the following: LPA Brown toured the entire facility with house manager. LPA obtained staff/clients roster, Residents #C1 physicians reports, IPP, behavior notes, incident report emergency contacts and Staff Members #1-2 training records. Interviews were conducted with Executive Director, staff members #1-#6 and Clients #C1. Client C2 is non-verable and C3 was not available.

Regarding the allegation: Multiple staff hit resident in care.
LIC 9099C is on the next page

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

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 11-AS-20220919153055

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: INTEGRATED TREATMENT SERVICES III	FACILITY NUMBER: 198603011
	VISIT DATE: 09/27/2022

NARRATIVE

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Details of the complaint is that a C1 was taking to a bathroom and was hit by multiple staff in the bathroom. On 9/27/22, LPA conducted interview with Executive director stated C1 had red marks on the face and on the upper back. Director had interview client and was told 3 staff took him to the bathroom and beat him up. She stated staff are on leave for further investigation. LPA conducted interviews with staff #1-4, staff stated have not witness any staff physically abusive to clients in the facility and staff stated clients have not mentioned to them they had sustained any physical abuse. Staff stated C1 will does fall at times or will lay on face and items will leave marks. On 9/27/22 interviewed C1, client stated likes living at the facility and is treated well by staff. LPA noticed a red spot on clients face and inquired. Client stated lays head down on table. On 9/27/22, LPA interviewed staff #5, stated around 9/6/22, C1 was taken to the bathroom by 3 staff members and was in there for a while . Staff stated did not hear or see any physical abuse but did notice a mark on C1's face. Staff stated the next day C1 stated was beaten up by staff members. LPA conducted interview with staff #6, stated has not witness any physical abuse of clients and did not see any marks on clients. Staff also stated no clients had brought to his attention of physical abuse. On 9/27/22 LPA reviewed incident reports, c1’s files and pictures, Staff #1-2 files. Based on interviews and documentation there is not enough evidence to support the above allegation.

Although the allegation is valid or may have happened there is insufficient evidence to support the alleged violations did or did not occur, therefore the allegation are unsubstantiated.

Exit interview conducted and a copy of the report was provided to Aubri Griffis.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 09/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022

LIC9099 (FAS) - (06/04)

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