198603011-3-30-2023-11-AS-MVAO-CQJUXT-20230403155853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603011
Report Date: 03/30/2023
Date Signed: 03/30/2023 02:51:21 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

PUBLIC

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:	03/30/2023
		UNANNOUNCED	TIME BEGAN:	01:27 PM
MET WITH:	Charles Elumelu-RBT		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Mulitple staff hit resident in care.

INVESTIGATION FINDINGS:

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The purpose of this report is to clarify the allegation findings narrative documented in the report created on 9/27/2022. The “Unsubstantiated” finding remains unchanged; however, this report was created on 3/30/2023 supersedes the complaint investigation report created on 9/27/2022. On 3/30/2023 LPA Brown met with Charles Elumelu and the purpose of the visit was explained.

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-Ingrid Wilson, staff members #1-#6 and Client #C1. Client C2 is non-verbal and C3 was not available for an interview.
LIC 9099C is continued on next page.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

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: 03/30/2023

NARRATIVE

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On 3/20/2023 LPA conducted a follow-up interview with Ingrid Wilson-Executive Director.
On 3/28/2023 and 3/29/2023, LPA conducted interview with (W1) who is with C1’s placement agency and 3 Staff (S7-S9).
The investigation revealed the following:

Regarding the allegation: Multiple staff hit resident in care.
On 9/27/2022, 3/28/2023 and 3/29/2023, LPA conducted interview Client (C1), Ingrid Wilson-Executive Director/Licensee, Staff (S1-S9) and (W1) who is with C1’s placement agency. LPA obtained the following documents for review: Unusual incident Report (date), staff/clients roster, Residents (C1’s) Physicians Reports, C1’s IPP, C1’s Behavior Notes, Client Emergency Contacts, and staff members training records.

The complainant alleges that C1 was taken to the bathroom and struck multiple times by staff members (S7-S9) on 9/14/2022. On 9/27/2022, LPA conducted an interview with Client (C1). During the interview, LPA observed a small red mark, approximately the size if a quarter, located on the left side of C1’s head. C1 stated,, “I like to lay my head on the table” when asked about the red mark. C1 stated , they are treated “good” by staff when asked about relationships with staff. On 9/27/2022, LPA conducted an interview with Ingrid Wilson-Executive Director, who stated C1 reported staff (S7-S9) struck C1 in the restroom on 9/14/2022, and this is why C1 has a small red mark. Ingrid Wilson- Executive Director also stated the (3) staff members are no longer working at the facility. LPA conducted interviews with Staff (S1-S6), (6) staff stated they have not witnessed the physical abuse of C1 or other clients while working at the facility. During interviews with staff, (3) of (6) staff stated they observed a red mark on C1’s head but it did not appear to be a bruise. Staff were unable to determine the cause of the mark on C1’s head. On 3/28/2023, LPA interviewed (W1) with C1’s placement agency. W1 stated, the placement was made aware of the abuse report and investigated the matter. Based on information gathered, W1 determined the origin of C1’s bruise may have been due to a fall. On 3/29/2023, LPA conducted telephone interviews with the (S7-S9 ), the staff who allegedly struck C1. Staff S7, S8, and S9 stated they were unaware of C1 having bruising. S7 and S8 denied any inappropriate physical contact other than providing support to C1 while in the shower and physically supporting C1 to the bedroom after as C1 is provided an enhanced ratio of 2:1 due to a history of falls. LPA found S9 was not present during C1’s shower on 9/14/2022 and made no contact with C1 in the restroom. During interviews conducted LPA found, approximately 2 days prior to 9/14/2022, C1 slipped and fell on laundry basket due to an unsteady gait. Based on interviews conducted and document reviewed, LPA was unable to gather sufficient evidence to support the allegation above.

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 is unsubstantiated.

An exit interview was conducted and a copy of the report was provided to Tony Houston-RBT.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Martessa Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023

LIC9099 (FAS) - (06/04)

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