198603269-5-1-2023-28-AS-DSIS-CT2TCJ-20230622143650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603269
Report Date: 05/01/2023
Date Signed: 05/01/2023 12:45:05 PM

Unsubstantiated

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
04/27/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230427085429

FACILITY NAME:	CENTER FOR BEHAVIORAL CHANGE #8		FACILITY NUMBER:	198603269
ADMINISTRATOR:	JASON PIGGEE		FACILITY TYPE:	735
ADDRESS:	645 S. INMAN ROAD		TELEPHONE:	(323) 816-4462
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	4	CENSUS: 3	DATE:	05/01/2023
		UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Latonya King		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Resident was bullied by staff
Staff pulled residents hair
Staff did not ensure that resident was adequately fed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced inital 10 days complaint investigation to address the abvoe allegation(s). LPA met wtih RBT Chinasa Nwachukwuu and allowed the entry of the facility and explained the reason of the visit. A while later, the administrator Latonya King arrived and assisted with the visit.

The investigation consisted of the following: LPA interviewd two clients (C2-C3) in the facility, attempted to interview one client in the facility (C4), three staff (S1-S3) , administrator, collateral visit with Client#1(C1) and obtained some copy of the documents for C1 including face sheet, Individual Progress Plan (IPP), Behavioral Annual Report, Administrator notes, Incident report and physician reprot

The investigation revelaed of the following: Allegation#1 "Resident was bullied by staff." LPA interviewed clients and two out of four denied the allegation and stated that staff never buliied clients and staff are good. (See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230427085429

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: CENTER FOR BEHAVIORAL CHANGE #8	FACILITY NUMBER: 198603269
	VISIT DATE: 05/01/2023

NARRATIVE

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LPA interviewed staff and staff denied the allegation. They never bullied clients or mean to clients. All staff have a good relationship with clients.

Allegation#2 "Staff pulled residents hair" LPA interviewed the clients and two out of four denied the allegation and reported they never witnessed or experienced any staff pulled clients hair. LPA interviewed staff and denied the allegation and reported all male clients have short hair and no hair to pull. For female client, they would never pull clients hair.

Allegation#3 "Staff did not ensure that resident was adequately fed" LPA interviewed clients and two out of four denied the allegation and stated that they always have enough food to eat and they always can get second if they wanted. LPA interviewed staff and staff said no clients ever complained they were not adequately fed. LPA also inspected the refrigerator and the food pantry. The facility has ample supply of 2 days perishable and 7 days non perishable food in the facility.

Based on the interviews conducted with clients and staff, record reviewed and observation, the 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 all the allegations are UNSUBSTANTIATED.

Exit interview conducted, and a copy of report and appeal right was provided to Administrator Latonya King.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC9099 (FAS) - (06/04)

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