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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603265
Report Date: 02/19/2025
Date Signed: 02/20/2025 10:41:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/31/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241231093016
FACILITY NAME:GHENTFACILITY NUMBER:
198603265
ADMINISTRATOR:BALLINGER ASHLEY D.FACILITY TYPE:
735
ADDRESS:18423 E. GHENT STTELEPHONE:
(626) 430-6101
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:4CENSUS: 4DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ashley Ballinger - AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Facility staff spoke inappropriately to resident(s)
INVESTIGATION FINDINGS:
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***This report supersedes report dated 02-15-25. The reason for superseding is to include missing information the LIC9099-C page and correct citation 80072(a)(3) issued on 2-15-25 from a Type B citation to a Type A. The substantiated findings remain the same.***

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced compliant visit. LPA met with Administrator Ashley Ballinger and explained the purpose for todays visit.

The investigation consisted of the following:
During initial visit on 1/2/25, LPA obtained copies of Staff and Client Roster, and copies of facility's most recent Special Incident Reports (SIR's) from Oct-Dec 2024, LPA toured facility and conducted Health and Safety Check with two clients that were present (nothing out of the ordinary observed), other 2 clients were away at day program. (Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 5
Control Number 28-AS-20241231093016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GHENT
FACILITY NUMBER: 198603265
VISIT DATE: 02/19/2025
NARRATIVE
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 During subsequent visit on 2/7/25 LPA obtained copies of relevant documents from Client #1's file, Interviews were conducted with 3 Staff and 3 Clients. LPA conducted interviews with Witness #1 (W1) on 2/12/25 via phone call, on 2/15/25 LPA delivered findings for the above-mentioned allegation, on 2/20/25 LPA delivered superseded report to facility with corrections.

The investigation revealed the following:
Allegation: Facility staff spoke inappropriately to resident(s)
It is alleged that Staff (S3) threatened C1, to not say anything or else they will be suffering the consequences. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation. S1 stated that there haven’t been any staff that have been written up for this type of behavior towards clients, S2 and S4 stated that they have never observed any staff including S3 be inappropriate toward clients. LPA interviewed S3 and staff denied the allegation and stated they have never threatened/intimidated/abused any of the clients. LPA interviewed 3 clients and 2 out of 3 clients confirmed the above allegation stating that S3 has threatened them and intentionally tries to scare them. LPA interviewed W1 and they also confirmed the above allegation stating they have seen S3 raise their hand towards C1 as if they were going to hit them, causing C1 to flinch and block their head. W1 stated that they have also overheard verbal abuse from S3 towards C1 on many occasions by S3 cursing at C1 and telling C1 if they had a bad day there will be problems.

Based on LPAs observations and interviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D. Exit interview held, and a copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20241231093016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GHENT
FACILITY NUMBER: 198603265
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/21/2025
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.

This requirement was not met as evidence by:
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Licensee/Administrator shall ensure that all clients are accorded personal rights. Licensee/Administrator to conduct a training for all staff on personal rights, with a focus on treating clients with dignity, respect and ensuring that all clients are free from humiliation, intimidation, and threats. A copy of the training materials, date of training and training log with participant names to be emailed to LPA by 2/21/25 (to clear the 24 hr requirement). Once training is completed Administrator to email a copy of the training log with participant signatures. (training must be held no later than 3/4/25.
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During interviews with 2 out of 3 clients 2 clients stated that they have been threatened and yelled/cursed at by S3. Interview with W1 revealed that they have personally witnessed S3 be verbally intimidating towards C1, has heard S3 curse at C1 and has seen S3 raise their hand as if they were going to hit C1, causing C1 to flinch and block their head.
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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: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/31/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241231093016

FACILITY NAME:GHENTFACILITY NUMBER:
198603265
ADMINISTRATOR:BALLINGER ASHLEY D.FACILITY TYPE:
735
ADDRESS:18423 E. GHENT STTELEPHONE:
(626) 430-6101
CITY:AZUSASTATE: CAZIP CODE:
91702
CAPACITY:4CENSUS: 4DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Ashley Ballinger - AdministratorTIME COMPLETED:
10:55 AM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Facility staff caused resident(s) to sustain multiple serious injuries.
INVESTIGATION FINDINGS:
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3
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5
6
7
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10
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12
13
***This report supersedes report dated 02-15-25. The reason for superseding is to include missing information the LIC9099-C page. The unsubstantiated findings remain the same.***

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced compliant visit. LPA met with Administrator Ashley Ballinger and explained the purpose for todays visit.

The investigation consisted of the following:
During initial visit on 1/2/25, LPA obtained copies of Staff and Client Roster, and copies of facility's most recent Special Incident Reports (SIR's) from Oct-Dec 2024, LPA toured facility and conducted Health and Safety Check with two clients that were present (nothing out of the ordinary observed), other 2 clients were away at day program.
(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20241231093016
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GHENT
FACILITY NUMBER: 198603265
VISIT DATE: 02/19/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Facility staff caused resident(s) to sustain multiple serious injuries
It is alleged that one of the staff members broke C1’s nose and also gave one of the clients two black eyes. During initial visit LPA observed C1 and did not see any bruising or redness on C1. LPA interviewed 4 staff and 4 out of 4 staff denied the above allegation and stated that C1 has behaviors in which C1 will cause injury to self by banging their head on the wall, floor or dresser. It was explained to LPA that on this occasion C1 was hitting their head on the corner of a dresser, was aiming for their eye and ended up hitting their nose, causing the injury. This was observed by S3 and S4 and per interviews with S3 & S4, both staff had to assist with a CPI hold on C1 several times before C1 was able to return to their normal baseline. LPA reviewed files for both S3 and S4, both had valid CPI certificates within files. LPA reviewed C1’s file, medical documents from incident were reviewed along with SIR’s explaining what happened and the story aligned with what was explained during interviews with S3 & S4. Review of C1’s IPP with Harbor Regional Center was reviewed and it documented history of aggressive outbursts and self-inflicting injuries. LPA interviewed 3 clients and 2 out of 3 clients denied the above allegation and stated that staff do not hit them or have caused them to suffer any injuries. LPA also interviewed W1 and they stated they have never seen staff hit a client.

Based on statements and interviews conducted with staff and clients, review of C1’s files and Staff Records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5