198603269-5-14-2024-28-AS-RORN-D6DLLN-20240619085121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603269
Report Date: 05/14/2024
Date Signed: 05/14/2024 12:32:16 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
05/10/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240510141722

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: 4	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Latonya King - Administrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff slapped resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation.LPA met with DSP Chinasa Nwachukwu who allowed the entry of the facility and explained the reason of the visit and shortly after, the Assistant Administrator Latonya King assisted with the visit.

The investigation consisted of the following:
On today's date, LPA interviewed three clients (C1-C3) and four staff (S1-S2), LPA reviewed S1's file, LPA also reviewed C1's file and obtained copy of the following documents: C1's Physician Report, Individual Program Plan (IPP), Behavioral Support, most recent Special Incident Reports (SIR's) of C1 and copy of 30-day eviciton notice.

(continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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-20240510141722

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: 05/14/2024

NARRATIVE

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The investigation revealed the following:
Allegation: Staff slapped resident.
It is alleged that S1 slapped C1 because C1 took a spoon to their room to eat cereal. LPA interviewed S1 and S1 stated they recall the incident but denied hitting/slapping C1. S1 stated that they were redirecting C1 along with S5, as C1 had been having behaviors in the days prior to this incident and in efforts to avoid C1 from destroying food, S1 tried attempted to grab the cereal bag but C1 resisted and interlocked their arm with S1, S5 then assisted to remove C1's grab on S1 and C1 proceeded to enter their room destroy bedroom window and call law enforcement. LPA spoke with S5 and they confirmed this story and stated they did not see S1 hit, slap or yell at C1 but did witness C1 display these behaviors towards staff and other clients in the facility. LPA interviewed a total of 5 staff during visit and 5 out of 5 staff stated that they have never seen a staff hit, slap or yell at any clients. Staff also stated that they have not seen S1 be aggressive in any way towards clients. During interview with S2, they stated that S1 has never been reprimanded for these types of accusations, file review for S1 did not have anything that revealed otherwise. LPA was able to interview 1 other Client and C2 stated that staff have never been aggressive towards them, C2 admitted that they have spat at a staff before and that staff was calm and did not get angry or become aggressive even after this incident. C2 stated that they feel safe at the facility and think staff treat clients with respect. LPA reviewed documents from C1's file and there is a history of C1 making false accusations and being violent towards staff and other clients documented within several IPP exams. During todays visit LPA met with a Regional Center staff who was at the facility doing a follow up visit with C1 regarding this same incident and stated that there were no concerns or further incidents mentioned during their interview with C1. LPA also interviewed C1 and they proceeded to indicate that S1 slapped them during this incident and denied any further incidents with staff.
Based on statements and interviews conducted with staff and clients, review of C1 and S1 files, there was not enough supportive evidence to concur with the reported allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Tena Herrera
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

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