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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603452
Report Date: 08/26/2022
Date Signed: 08/26/2022 08:31:34 AM

Substantiated


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
03/15/2022 and conducted by Evaluator David Sicairos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220315123814
FACILITY NAME:DHASA CARE IIFACILITY NUMBER:
198603452
ADMINISTRATOR:CARTER, S'HALANAFACILITY TYPE:
735
ADDRESS:757 MILLBURY AVETELEPHONE:
(773) 718-0819
CITY:LA PUENTESTATE: CAZIP CODE:
91746
CAPACITY:4CENSUS: 3DATE:
08/26/2022
UNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Jasmin Rangel; DSPTIME COMPLETED:
08:46 AM
ALLEGATION(S):
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Staff inappropriately touched a client while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) David Sicairos conducted a subsequent complaint visit to deliver investigation findings regarding the above stated allegation. LPA met with Jasmin Rangel and explained the reason for the visit. Administrator S'Halana Carter was called during the visit and was provided with details of the visit.

Investigation consisted of the following: During the initial visit conducted on 03/16/22, LPA requested copies of Client & Staff Rosters and conducted a tour of facility including the common areas. LPA also obtained copies from Client #1 (C1) file.

Investigation revealed the following: in regards to the allegation "staff inappropriately touched a client while in care", this allegation was investigated by the Investigations Branch. Investigator interviewed C1, facility staff, and Administrator. S1 was not interviewed as to not interfere with the current criminal investigation/potential criminal proceedings. Per C1 statement and LASD Report, S1 touched C1's private areas. S1 confessed to touching C1's breasts. Therefore there is sufficient evidence to support the finding of substantiated for the allegation.

(CONTINUED ON 9099C)
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
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 3
Control Number 28-AS-20220315123814
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: DHASA CARE II
FACILITY NUMBER: 198603452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2022
Section Cited
CCR
80072(a)(1)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:

(1) To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement is not met as evidenced by:
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Administrator/Licensee to ensure clients are accorded dignity in his/her personal relationships with staff and other persons at all times. Administrator/Licensee to submit self-certification (LIC9098) indicating facility will ensure clients personal rights are not beling violated by POC due date.
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Based on investigation conducted by Investigation Bureau, it was determined S1 inappropriately touched C1. This poses an immediate health, safety, and/or personal rights risk to the clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20220315123814
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: DHASA CARE II
FACILITY NUMBER: 198603452
VISIT DATE: 08/26/2022
NARRATIVE
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Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview held and a copy of this report along with appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Stefanie Coronel
NAME OF LICENSING PROGRAM ANALYST: David Sicairos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3