198603443-11-5-2024-28-AS-TVAO-DAZP5J-20241114100046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603443
Report Date: 11/05/2024
Date Signed: 11/05/2024 10:16:39 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
10/07/2024 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20241007152554

FACILITY NAME:	DHASA CARE		FACILITY NUMBER:	198603443
ADMINISTRATOR:	DEBELA-SLEDGE, HURUBE		FACILITY TYPE:	735
ADDRESS:	2181 LARCHMONT ST		TELEPHONE:	(773) 718-0819
CITY:	POMONA	STATE: CA	ZIP CODE:	91767
CAPACITY:	4	CENSUS: 2	DATE:	11/05/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Emmanuel Chukwudi/S-2		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff member handled client in care in a rough manner.
Staff member threatened client in care.
Staff member yelled at client in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Elizabeth Irra and Mayra Cota conducted a subsequent visit to investigate the above allegations. LPA met with Emmanuel Chukwudi/S-2 and discussed the purpose of today's visit.

During the 10/14/24 visit, LPA Irra obtained a copy of the staff contact information and client roster, interviewed Staff #1 (S-1), interviewed Client #2 (C-2) and Client #3 (C-3) and reviewed file for Client #1 (C-1) and obtained relevant documentation. LPA was unable to interview C-1 as C-1 was not present during this visit.

During the course of this investigation, LPA also interviewed, Staff #2 (S-2), Staff #3 (S-3) and Staff #4 (S-4). LPA was unable to interview C-1 as C-1 no longer resides at this facility. LPA also had contact with C-1’s Regional Center representative. ****Refer to LIC 9099C for the continuation of this report.***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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-20241007152554

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: DHASA CARE	FACILITY NUMBER: 198603443
	VISIT DATE: 11/05/2024

NARRATIVE

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Allegation: Staff member handled client in care in a rough manner. It has been alleged that on 09/22/24, S-1 grabbed C-1 by the neck. Staff interviews (including S-1) revealed that staff do not handle clients in a rough manner. Staff interviews indicated they have not witnessed any staff (including S-1) handling clients in a rough manner. Interviewed staff indicated they have not received any complaints regarding this matter. Staff interviews revealed that on 09/22/24, C-1 had a behavior in which C-1 broke the bedroom window and AWOL this facility. Per staff interviews, this incident warranted police assistance in which C-1 was taken to the hospital for an evaluation and later discharged back to this facility. Interviewed staff indicated they are trained in mandated reporting and zero tolerance. Client interviews revealed that staff do not handle clients in a rough manner. Interviewed clients indicated they have not witnessed any staff (including S-1) handling clients in a rough manner. Interviewed clients indicated they have no concerns regarding this matter. Interviewed clients also revealed that C-1 had broken C-1’s bedroom window in September and left this facility. Interviews do not corroborate this allegation.

Allegation: Staff member threatened client in care. It has been alleged that that on 09/22/24, S-1 threatened to fight C-1 back. Staff interviews indicated they have not witnessed any staff (including S-1) threatening clients (including C-1 and threatening C-1 in fighting back). Interviewed staff indicated they have not received any complaints regarding this matter. Interviewed staff indicated they are trained in mandated reporting and zero tolerance. Client interviews revealed that staff do not threaten clients. Interviewed clients indicated they have not witnessed any staff (including S-1) threatening clients (including C-1). Interviewed clients indicated they have no concerns regarding this matter. Interviews do not corroborate this allegation.

Allegation: Staff member yelled at client in care. It has been alleged that that on 09/22/24, S-1 started yelling at C-1. Staff interviews (including S-1) revealed that staff do not yell at clients (including C-1). Staff interviews indicated they have not witnessed any staff (including S-1) yelling at clients (including C-1). Interviewed staff indicated they have not received any complaints regarding this matter. Interviewed clients indicated they have not witnessed any staff (including S-1) yelling at clients (including C-1). Interviewed clients indicated they have no concerns regarding this matter. Interviews do not corroborate this allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted, a copy of the Appeal Rights and this report was provided to Emmanuel Chukwudi/S-2.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

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