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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603265
Report Date: 04/15/2022
Date Signed: 04/15/2022 04:30:00 PM

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
04/08/2022 and conducted by Evaluator Nune Margaryan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220408172336
FACILITY NAME:GHENTFACILITY NUMBER:
198603265
ADMINISTRATOR:SMITH, JAYFACILITY TYPE:
735
ADDRESS:18423 E. GHENT STTELEPHONE:
(855) 302-3331
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:4CENSUS: 4DATE:
04/15/2022
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Daisy Moreno TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff used an inappropriate form of discipline towards clients.
Staff restrained client in an inappropriate manner.
Staff threatened client with an object.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint inspection on the above allegations. LPA arrived unannounced and met with Administrator Daisy Moreno. Shortly after House manager Juana (Ivett) Bubsy arrived. LPA explained the purpose of the inspection.

The investigation consisted of the following: LPA obtained copies of client and staff rosters, copy of Incident reports. LPA also reviewed Client #1's file and obtained copies of Face Sheet, most recent IPP, Appraisal/needs and services plan. LPA also interviewed Client #1 (C1), Client #2 (C2), Staff #1 (S1) to Staff #5 (S5). Client #3 (C3) and Client #4 (C4) were not interviewed as both are non-verbal. The facility is vendored through San Gabriel Valley/Pomona Regional Center.

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: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
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-20220408172336
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: GHENT
FACILITY NUMBER: 198603265
VISIT DATE: 04/15/2022
NARRATIVE
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The investigation revealed the following:
Staff used an inappropriate form of discipline towards clients. It was alleged that staff discipline C1 making C1 stand up against the wall with hands up. To investigate this allegation LPA spoke with the staff and clients. Staff interviews revealed that staff never used exercise as a form of discipline to C1. Staff never forced C1 or other clients do any exercise/activity if they don't want to do it. Staff will not discipline C1 or other clients. They will calm them down if they are upset or aggressive.. LPA interviewed C1 and C2. Both stated staff didn't discipline them. They stated staff is nice.

Staff restrained resident in an inappropriate manner. It was alleged that staff restrained client getting on top of them and making client count to 10. Interviewed staff stated that C1 was not restrained. The administrator said they do not utilize restrains, but instead use verbal intervention with the clients. Interviewed staff denied the allegation. Staff never restrained client in an inappropriate manner. C1 stated that staff did not restrain him. C2 stated staff didn't restrained C1. No one witnessed staff restraining C1. LPA observed that staff to be respectful towards clients.

Staff threatened resident with an object. It was alleged that Staff 4 tapped the bat on C1's head and told client would hit C1 with it. All interviewed staff denied that a staff member threatened a resident with an object. Staff 2 and Staff 3 reported working the day of incident and stated that staff 4 was not holding any object in their hands. Staff 4 denied the allegation. S4 stated that never threatened C1 or other clients. C1 stated no one hit him with the bat or other object. Staff and clients have never witnessed that staff threaten a client with an object. Administrator indicated that staff very well versed in their roles and were helpful with each client.

Based on statements and interviews conducted with staff, clients and review of client files there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.



Exit interview held, and a copy of this report was provided.


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

DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2