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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603452
Report Date: 11/10/2022
Date Signed: 11/10/2022 02:51:30 PM

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
11/04/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20221104093303
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: 4DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:George Mannie Omunguye/S-1TIME COMPLETED:
03:05 PM
ALLEGATION(S):
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Client was physically abused by staff.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial 10 day complaint visit to investigate the above allegations. LPA was allowed entry by George Mannie Omunguye/S-1. LPA discussed the purpose of today's visit.

During this investigation, LPA obtained a copy of the client roster, staff roster, interviewed staff #1 through staff #3 (S-1 through S-3), interviewed client #1 (C-1) and client #4 (C-4). LPA was unable to interview Client #2 (C-2) and Client #3 (C-3) as both are non-verbal. LPA also reviewed file for C-1 and obtained relevant documentation.

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: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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-20221104093303
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 II
FACILITY NUMBER: 198603452
VISIT DATE: 11/10/2022
NARRATIVE
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Allegation: Client was physically abused by staff. Staff interviews revealed that staff do not abuse clients (including physically). (2) out of (3) interviewed staff indicated that on 11/02/2022, C-1 came home from day program agitated and hit S-2 on the arm. Staff interviews revealed that staff did not grab C-1's arm, did not put C-1's arm behind C-1's back and did not throw C-1 on the ground. Per staff interviews, S-2 asked C-1 to go to C-1's room for de-escalation. Staff interviews also revealed that S-2 did not and does not poke fingers onto C-1's chest nor any other clients' chest. (1) out of (3) interviewed staff members indicated that on 11/03/2022, C-1 informed staff that C-1 had fabricated the allegation of S-2 hitting C-1. (3) out of (3) staff interviews revealed that C-1 has a history of fabricating stories and that this behavior is being tracked by staff and reported to C-1's behaviorist. (1) out of (2) interviewed clients indicated C-1 hit S-2 on the arm unprovoked and then alleged that S-2 hit the C-1. (1) out of (2) interviewed clients indicated staff (including S-2) do not hit clients. LPA was unable to interview (2) out of (4) clients as they are non-verbal. LPA also collected relevant documentation. Interviews and collected documentation do not corroborate this allegation.

Based on LPA's observations and interviews, investigation revealed: Although the allegations 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, appeal rights and a copy of this report was provided to George Mannie Omunguye/S-1
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Elizabeth Irra
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2