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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603265
Report Date: 03/13/2025
Date Signed: 03/13/2025 02:18:46 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
03/04/2025 and conducted by Evaluator Nune Margaryan
COMPLAINT CONTROL NUMBER: 28-AS-20250304094911
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:
03/13/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:William HarrelTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff caused injury(ries) to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Nune Margaryan conducted unannounced complaint visit to the facility to investigate the above noted allegation. LPA met with William Harrel. Shortly after Administrator arrived. LPA explained the purpose of the visit.

The investigation consisted of the following: LPA toured the facility, obtained copies of client and staff rosters, copy of Incident reports dated 03/02/25 and 03/03/25. LPA also reviewed Client #1's file and obtained copies of Face Sheet, Physician's report, most recent IPP, Appraisal/needs and services plan, Functional Capability Assessment, Body assessment sheet / body chart, Daily notes. LPA also interviewed Client #1 (C1) and Client #2 (C2), Staff #1 (S1), Staff #2 (S2) and Administrator. S2, C1 and C2 were interviewed over the phone. At the time of visit C1 was at the school and C2, C3 were at the day program. C4 was sleeping in their room.

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: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
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 2
Control Number 28-AS-20250304094911
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: 03/13/2025
NARRATIVE
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Regarding Allegation: Staff caused injury(ries) to resident. It was alleged that staff hit the client and caused an injuries to client.
Interviewed Administrator and staff denied the allegation: Staff at the facility didn't hit the clients or caused injury to the clients and didn't witness that other staff hit or cause injury to clients. Interviewed Administrator and staff stated that C1 has self injurious behaviors, and a history of making false allegations. Review of C1's file / IPP, indicates that C1 has self injurious behaviors and a history of making false allegations.

Staff interviewed stated that C1 scratching thyself, throwing thyself into wall and banging their head on the wall. Administrator stated that last episode was on 03/02/25. C1 kicked walls with feet and left toe discolored and marked. LPA observed facility notes, body check chart which documented marks or injuries observed by staff. Administrator had provided an incident report of 03/02/25 for C1 where C1 hit the walls with their back and feet, putting holes in the walls. Interviewed C1 and C2 stated that they are okay, and staff didn't hit them. Interviewed C2 stated they afraid of C1 and C4, because C1 and C4 are aggressive and screaming and yelling a lot. Interviewed C1 and C2 stated don’t know individual who mentioned in the complaint report as staff. Upon review of the staff roster LPA observed the name that was given as staff on the complaint report was not on the Personnel Report (LIC500). Interviewed Administrator confirmed and verified that the individual mentioned in the complaint report as facility staff has not been personnel of the facility or is current employee.

Based on file reviews, observation and interviews, 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

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: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2