198603369-3-11-2024-28-AS-FFIS-D4MT72-20240424142759

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603369
Report Date: 03/11/2024
Date Signed: 03/11/2024 01:03:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/05/2024 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240305111858

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:	03/11/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator Adedolapo Olusoji		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff inappropriately restrained a resident while in care.
Staff hit a resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint inspection visit for the allegations above. LPA met with staff Jennifer Ogudu and explained the purpose of the visit. Administrator Adedolapo Olusoji arrived shortly after.

On todays visit, LPA interviewed clients #1-#2 (C1-C2) and Staff #1-#5 (S1-S5). LPA reviewed and collected copies of the staff roster, client roster, and S4 and S5's file. LPA collected and reviewed the following documents from C1's file : Facsheet, Incident Reports for the last month, Physicians report, Urgent Care visit dated 3/7/24, Placement Agency's Notes, and the Individual Program Plan.

The investigation revealed the following:
In regards to the allegation "Staff inappropriately restrained a resident while in care" it was alleged that on 3/2/24 staff on duty restrained C1 during a behavior incident by using a choke hold. (5) of (5) Staff interviewed denied the allegation... Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

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-20240305111858

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: DAZION INC	FACILITY NUMBER: 198603369
	VISIT DATE: 03/11/2024

NARRATIVE

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(1) of (2) Clients interviewed could not corroborate the allegation. Interviews state that on 3/2/24, C1 arrived home agitated from being out in the community and began to physically assault S4 in the kitchen area as S4 sat on the kitchen chair. S5 attempted to separate C1 from S4 by placing themselves in the middle and blocking C1's arms. From there C1 then began to bite S5. S4 was able to separate and call the cops. C1 stated one of the staff did use a choke hold but did not know which staff. Staff interviewed denied ever using a choke hold on C1 as they are not allowed to do that. File review shows S4 and S5 have CPI training, which consists of verbally redirecting, giving space, and using coping skills, to handle Client behaviors. They cannot hold down a client but could utilize blocking techniques. File review also shows the incident occurred and police were called. Police report collected verifies the date of incident but does not provide information regarding the incident. Based on interviews, files reviewed and observations; 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.

In regards to the allegation "Staff hit a resident while in care" it was alleged that Staff punched C1 in the face on 3/2/24. (5) of (5) Interviewed denied the allegation. (2) of (2) Clients interviewed could not corroborate the allegation. LPA did observe C1 to have a red eye during the visit. C1 stated that they were not punched in the eye or face but one of the staff might have grabbed their eye while C1 on 3/2/24. C1 added that they were trying to bite and punch staff and maybe that they injured their eye on the chairs or table. Staff interviewed stated that no one punched C1 or pulled C1's eye. It is possible C1 hurt themselves when throwing punches and stumbling across the kitchen on the day of the incident. File review shows that C1 was taken to urgent care on 3/7/24 and had a diagnosis/observation of eye trauma. There is no documentation observed that stated the trauma to have been caused specifically by being punched. Based on interviews, files reviewed and observations; 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.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

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