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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603269
Report Date: 10/20/2022
Date Signed: 10/20/2022 02:07:05 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
10/18/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221018111855
FACILITY NAME:CENTER FOR BEHAVIORAL CHANGE #8FACILITY NUMBER:
198603269
ADMINISTRATOR:JASON PIGGEEFACILITY TYPE:
735
ADDRESS:645 S. INMAN ROADTELEPHONE:
(323) 816-4462
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:4CENSUS: 4DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Latonya King TIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Facility is not providing resident adequate supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint to investigate the above allegation. LPA met with house manager Nieri Waldron and explained the purpose of the visit. Shortly after, the administrator Latonya King arrived and assisted with the visit.

The investigation consisted of the following: LPA interviewed three clients (C2-C4) in the facility and Client#1(C1) via phone. LPA also interviewed administrator and five staff (S1-S5). LPA also obtained C1's placement information, IPP dated on 8/8/22, behavioral assessment dated on 7/31/22, CBEM Introductory Safety Plan and incident report dated on 10/18/22, 9/19/22, 8/4/22, 8/3/22 and 7/30/22.

The investigation revealed of the following: In regard the allegation "Facility is not providing resident adequate supervision"

See LIC9099C for continuation
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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-20221018111855
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: CENTER FOR BEHAVIORAL CHANGE #8
FACILITY NUMBER: 198603269
VISIT DATE: 10/20/2022
NARRATIVE
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LPA interviewed four clients and all denied the allegation. All four clients reported they feel safe living in the facility and staff are always supervised them very well and have no issues with the staff. LPA interviewed staff and all denied the allegation. The administrator reported on Monday 10/17/22, C1 was having a behavior after having a meeting with the counselors from Creating Behavioral Educational Momentum (CBEM) and C1 began screaming and yelling and ran out of the facility, and climbed the gate and jumped over the wall so fast and ran on the street, facility staff immediately followed C1 and ran on the street after him, redirected C1 and attempted to calm C1 down but C1 refused to go back to the facility. Staff never left C1 alone and were with C1 the whole time. They kept convincing C1 to go back to the facility and staff also called the police. Eventually C1 went back to the facility before the police arrived.

Based on LPA interviews conducted, recorded review and observation, investigation revealed: Although the allegation 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 allegation is UNSUBSTANTIATED.

Exit interview conducted, and a copy of report and appeal right was provided to Administrator Latonya King.
NAME OF LICENSING PROGRAM MANAGER: Christine Yee
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2