198603369-11-2-2023-28-AS-TVAO-CXBUQ7-20231106144641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603369
Report Date: 11/02/2023
Date Signed: 11/02/2023 11:21:33 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
10/05/2023 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231005142500

FACILITY NAME:	DAZION INC		FACILITY NUMBER:	198603369
ADMINISTRATOR:	ADEDOLAPO OLUSOJI		FACILITY TYPE:	735
ADDRESS:	734 GLENEAGLES AVENUE		TELEPHONE:	(909) 233-4528
CITY:	POMONA	STATE: CA	ZIP CODE:	91768
CAPACITY:	4	CENSUS: 4	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Jennifer Ogudu, Staff		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff engaged in a physical altercation with client, resulting in client sustaining an injury.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegation listed above. LPA met with Staff, Jennifer Ogudu, and explained the purpose of the visit.

The investigation consisted of the following:
On 10/10/23, LPA conducted the initial visit and obtained copies of the staff roster, client roster, and documents for Client #1. LPA interviewed the administrator, 3 Staff, and Client #1. Another Staff was interviewed via telephone on another date.

The investigation revealed the following:
Allegation - Staff engaged in a physical altercation with client resulting in client sustaining an injury. It is alleged that a staff wrestled and pinned down Client #1 (C-1), causing an injury to the right ring finger.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

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 2

Control Number 28-AS-20231005142500

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: DAZION INC	FACILITY NUMBER: 198603369
	VISIT DATE: 11/02/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA conducted interviews with the administrator, Staff, and C-1. The 3 staff on duty during the incident denied wrestling or touching C-1. Per staff interviews, Staff #1 (S-1) and Staff #2 (S-2) were in the kitchen discussing the menu. C-1 came over and accused them of talking about him/her. C-1 became enraged, threw a sandal at staff, and charged towards S-2. S-1 intervened by standing in the middle to block C-1 from striking S-2. S-2 ran outside to inform another Staff (S-3) and was instructed to call 911. The other 2 staff proceeded to talk to C-1 to calm client down and denied pushing or holding down C-1. They checked C-1 and asked if there were any injuries after the incident. C-1 was given an ice pack for the pain indicated on the hand, but client refused to go to the hospital for medical assessment. Staff stated they did not observe any body parts bruised or swollen. The police responded to the incident and C-1 did not report any injuries to them either.

According to the administrator and staff, C-1 has a history of aggressive behavior and had attacked staff in the past. C-1’s behavioral progress reports show the facility is working with client to reduce problem behaviors such as physical aggression, emotional outburst, just to name a few, and to increase appropriate behaviors. Staff have CPI training, which consists of verbally redirecting, giving space, and using coping skills, to handle C-1’s behaviors. They cannot hold down the client but could utilize blocking techniques when C-1 strikes. Based on the information gathered, Staff did not engage in any physical altercation and caused injury to the client.

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.

An exit interview was conducted with Jennifer Ogudu. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2