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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603226
Report Date: 03/19/2024
Date Signed: 03/19/2024 10:55:17 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/11/2024 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20240311132518
FACILITY NAME:INSIGHT FOR LIFE @3RD AVEFACILITY NUMBER:
198603226
ADMINISTRATOR:ESCORCIA, ROGERFACILITY TYPE:
737
ADDRESS:549 S. 3RD AVETELEPHONE:
(626) 945-2709
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:3CENSUS: 2DATE:
03/19/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cesar Villa TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Items that pose a danger are stored in an unlocked cabinet
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted an initial complaint visit to investigate the above allegation. LPA met with Cesar Villa who called the Administrator and notified about the visit. Administrator arrived shortly after. The purpose of visit was explained.

During today's visit, LPA toured the physical plant including kitchen, medication area / closet and attached garage, requested, and obtained a copy of staff and clients roster. Interviews conducted with Administrator, Staff # 1 - Staff #4 (S#1 - S#4).

Continue 9099C.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
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 2
Control Number 28-AS-20240311132518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: INSIGHT FOR LIFE @3RD AVE
FACILITY NUMBER: 198603226
VISIT DATE: 03/19/2024
NARRATIVE
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Regarding allegation: Items that pose a danger are stored in an unlocked cabinet. It was alleged that sharps are stored in an unlocked filing cabinet in the garage.

During today’s visit LPA observed that all sharps and knives are stored in the locked kitchen drawer between the stove and refrigerator, and in the locked medication closet. Sharps in the medication closet were locked in the safe. Interviewed Administrator and staff denied the allegation. They stated that sharps and knives always locked at the facility no matter where they are. They stated that sharps were locked in the kitchen before, but staff moved them to the garage about 2 months ago which always locked with the keypad lock. Staff move the sharps to the garage because of one of client’s behavior who was resides at the facility about 2 months. Client moves from the facility on March 1st. At the time of visit LPA didn't observe any unlocked items including sharps that pose a danger to clients in care. All sharps are locked and inaccessible to the clients.

Based on inspection, observation, and interviews there is no sufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted, and a copy of this report was provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2