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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603273
Report Date: 02/20/2025
Date Signed: 02/20/2025 11:31:18 AM

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
01/14/2025 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250114130236
FACILITY NAME:BRADBOURNEFACILITY NUMBER:
198603273
ADMINISTRATOR:PEREZ, JOEYFACILITY TYPE:
735
ADDRESS:1332 BRADBOURNETELEPHONE:
(855) 302-3331
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:4CENSUS: 4DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH: Ashley Ballinger - AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff engaged in a physical altercation with resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent visit to continue with the investigation of the above allegation. LPA met with Marco Zuniga, (DSP I & II) and explained the purpose of the visit. At 11am, Administrator Ashley Ballinger arrived and assisted LPA.

The investigation consisted of the following: On 1/21/2025, LPA Pena obtained copies of the staff & client rosters, Staff In service training logs (Zero Tolerance Policy and Mandated Reporting) Client #1 (C1) pertinent files, interviewed Staff #1 (S1) - Staff #3 (S3) and Client #1 (C1). Prior to today’s visit, LPA telephonically interviewed Client #3 (C3)-Client #4 (C4), Staff #4 (S4) and attempted to call San Gabriel/Pomona Regional Center's Service Coordinator (SC) 3x but unsuccessful due to no response received.

During today’s visit, LPA obtained copies of the staff & client rosters, C1’s latest IPP (dated 09/13/2023),Psychiatric Medication Consultation Notes (dated 12/20/2024) and Crisis Prevention Intervention (CPI) training certificates for Staff #1 (S1) - Staff #3 (S3) and the Unusual/Incident/Injury Report (SIR/dated 01/11/2025). ***CONTINUED ON LIC9099-C***
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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-20250114130236
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: BRADBOURNE
FACILITY NUMBER: 198603273
VISIT DATE: 02/20/2025
NARRATIVE
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The investigation revealed the following:

In regards to the allegation: "Staff engaged in a physical altercation with resident." It is alleged that a staff member began a physical altercation with C1 by hitting and throwing a plate at C1. It is also alleged that C1 was injured and bled from the right ear and altercation escalated when other staff members restrained C1. (4) out of (4) staff interviewed all denied the allegation and indicated that they have never engaged nor have they observed other staff members engaged in a physical altercation with clients. S1-S3 who were present during the incident stated that C1 was upset because a house mate provoked him and felt that the staff sided with the other house mate. This led C1 to become agitated and started to scream and act aggressively, including throwing food at S3, kicking a filing cabinet, and banging on C1's bedroom door. S1 and S3 attempted to de-escalate the situation through verbal redirection and gave C1 space. However, C1 continued to act aggressively by flipping the dining table, spitting on staff, and tried to charge at S1 and S3. S1 stated that physical intervention is their last resort, however due to the situation, S1 and S3, who are CPI trained, used a CPI hold on C1 to ensure safety as C1 was becoming a danger to himself and others. As a result, C1 damaged his bedroom door and scratched his ear. After C1 calmed down, S1 checked C1 for injuries and found only a scratch on C1's ear. The staff provided first aid, without the need for hospitalization. LPA's review of C1's records revealed that C1 has a history of challenging behaviors including verbal and physical aggression/threats, emotional outbursts, fabricating stories, self-injurious behaviors, and property destruction. Reviewed records also noted that S1 and S3 are trained in CPI, with certifications valid until Aug 2026 and Dec 2026, respectively. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with clients and staff as well as reviewed files and documentation, there was not enough supportive evidence to corroborate the allegation.

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 conducted and a copy of this report was provided to the Administrator, Ashley Ballinger.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2