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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603269
Report Date: 09/12/2023
Date Signed: 09/12/2023 11:50:16 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
09/05/2023 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230905115636
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: 3DATE:
09/12/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Latonya King TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Due to lack of supervision residents wander around
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint ” to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with DSP Chinasa Nwachukwu who allowed the entry of the facility and explained the reason of the visit and shortly after, the administrator Latonya King arrived and assisted with the visit.

The investigation consisted of the following: On today's date, LPA interviewed three clients (C1-C3), administrator and two staff (S1-S2) in the facility and two staff (S3-S4) via telephone and reviewed C1's documents and obtained copy of the documents included : C1's face sheet, Individual Program Plan and Behavioral Support.

(See LIC 9099C for continuation)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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-20230905115636
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: 09/12/2023
NARRATIVE
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The investigation revealed of the following: Allegation "Due to lack of supervision residents wander around" It's alleged that C1 was upset because of one of the gaming devices log in password was not working and had a bad behavior episode and went out to the backyard and jumped over the wall to the neighbor's backyard. Administrator reported C1 ran so fast and no one could stop him. The staff attempted to redirect him verbally and calm him down but when C1's behavior got triggered, he would never be able to listen to anyone. According to the administrator, C1 does not have a 1:1. Although it does not happen daily or weekly, the episodes of C1 jumped over the wall to the neighbor's house did happened few times already. The police and code enforcement were aware of and had been to the facility few times too.

Based on LPA’s interviews and records review, the preponderance of evidence standard has been met; therefore, the above allegation 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 conducted and a copy of the 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: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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
09/05/2023 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20230905115636

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: 3DATE:
09/12/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Latonya King TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not provide a safe environment for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christine Wong conducted an iniitla 10 days complaint ” to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with DSP Chinasa Nwachukwu who allowed the entry of the facility and explained the reason of the visit and shortly after, the administrator Latonya King arrived and assisted with the visit.

The investigaiton consisted of the following: On today's date, LPA interviewed three clients (C1-C3), administrator and two staff (S1-S2) in the facility and two staff (S3-S4) via telephone and reviewed C1's documents and obtained copy of the documents included :

(See LIC 9099C 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: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
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-20230905115636
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: 09/12/2023
NARRATIVE
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The investigation revealed of the following: Allegation "Staff did not provide a safe environment for residents" LPA interviewed clients and they all denied the allegation and they all feel safe living in the facility. LPA interviewed staff and all denied the allegation and reported they do the best as they can to provide a safe environment for the clients. They would attempt to redirect the client and calm them down but sometimes client was not able to listen. In addition, clients are adult and they have their right to do whatever they want. Staff always try to ensure clients are not hurting themselves or getting injury at 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 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: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 28-AS-20230905115636
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/26/2023
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs.
The requirement was not met as evidenced by:
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Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator/Licensee to submit a faxed or mailed copy of POC by due date.
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By LPA's interviews with staff and document reviewed, C1 would jump over the wall to neighbor's house and it happened few times, although staff attempted to redirect C1, C1 would not be to listen to staff and city police and code enforcement were aware and went to the facility few times.
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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: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5