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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603269
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:27:08 PM

Document Has Been Signed on 11/21/2024 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE #8FACILITY NUMBER:
198603269
ADMINISTRATOR/
DIRECTOR:		JASON PIGGEEFACILITY TYPE:
735
ADDRESS:645 S. INMAN ROADTELEPHONE:
(323) 816-4462
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 4CENSUS: 4DATE:
11/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:LaTonya King, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Daniel Konishi conducted a case management visit in response to an Investigation Report from the San Gabriel Pomona Regional Center that was received on 11/20/2024. The report indicated that on 10/23/2024, Client #1 (C1) accused Staff #1 (S1) of attempted sexual assaulting C1 at a previous placement and climbed on top of C1. Facility sent a Special Incident Report (SIR) to San Gabriel Pomona Regional Center on 10/24/2024 regarding this information. LPA discussed the purpose of the visit with the Assistant Administrator.

The investigation consisted of the following: LPA requested a copy of staff and client roster. LPA conducted interviews with the Assistant Administrator, S1, and C1. LPA obtained the SIR of the incident dated 10/24/2024. Based on the LPA interviewing the Assistant Administrator, S1, and C1, all confirm that no incident of abuse occurred at the time of the incident reported. Based on interviewing Assistant Administrator, S1, and C1, all confirm with the information of no incident of sexual abuse in the report from the San Gabriel Pomona Regional Center.



San Gabriel Pomona Regional Center conducted an investigation on 10/31/2024. Based on interviews, C1 did not report of any concerns of abuse from staff. Assistant Administrator stated that C1 reported S1 raped and climbed on top of C1 at previous placement and that the local police department and San Gabriel Pomona Regional Center were reported. However, the local Police Department and San Gabriel Pomona Regional Center confirmed not receiving any reports of this incident. Based on interview of S1, S1 stated C1 would be fine but claimed C1 yelled at S1 raped C1. This was reported to the police department without further incident. West Covina Police Department visited C1 on 10/25/2024. San Gabriel Pomona Regional Center and the Police both confirmed this matter would not be elevated but rather documented since no information was provided by C1. Based on the interviews and documentation, the allegation of abuse was unsubstantiated by San Gabriel Pomona Regional Center with the investigation completed on 11/13/2024.

No deficiencies were issued at this time. An exit interview was held and a copy of this report was given to the Assistant Administrator.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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