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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603369
Report Date: 05/12/2022
Date Signed: 05/12/2022 02:29:37 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
04/18/2022 and conducted by Evaluator Tony Vasallo
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220418083912
FACILITY NAME:DAZION INCFACILITY NUMBER:
198603369
ADMINISTRATOR:ADEDOLAPO OLUSOJIFACILITY TYPE:
735
ADDRESS:734 GLENEAGLES AVENUETELEPHONE:
(909) 233-4528
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY:4CENSUS: 4DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
01:51 PM
MET WITH:Edwin Offor, DSPTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff handles residents roughly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit to investigate the allegation listed above. LPA met with staff member, Edwin Offor and explained the reason for the visit. Administrator was called and notified of the visit. The initial complaint visit was conducted on 4/25/22. The purpose of today's visit was to interview Client #1 (C1) who was not present during the initial visit.

The investigation consisted of the following: During the initial visit, interviews were conducted with 3 staff and the facility was toured. Client records were reviewed which included Individual Program Plans (IPPs), daily notes, and client body checks. 3 out of the 4 clients were interviewed and LPA confirmed 2 out of the 3 clients present were non-verbal. LPA obtained staff contact information to conduct additional interviews. An additional 4 staff were interviewed after the initial visit.

The investigation revealed the following: It's allegedly staff are rough with clients and as a result clients have bruising. The verbal client indicated he/she likes living at the facility and did not report any abuse.
Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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-20220418083912
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: 05/12/2022
NARRATIVE
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LPA attempted to interview C1 during today's visit. It was confirmed C1 is non-verbal and unable to answer LPA's questions. During interviews with all 4 clients, LPA did not observe any visible bruises. An additional staff member was interviewed today for a total of 8 staff interviews. Staff deny clients have any suspicious bruising. Staff report that C1 has a bruise on the ankle. C1 went to the hospital in March 2022 for a swollen ankle. The hospital placed a boot on C1 to stabilize the ankle. When the boot came off, staff noticed the bruising. The daily body check forms were reviewed. Staff documented the bruise on the ankle and completed an incident report to licensing. There were no other bruises noted on C1 or any other clients. Based on interviews conducted and records reviewed, the allegation is unsubstantiated.

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. A copy of the report was provided.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Tony Vasallo
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2