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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603471
Report Date: 02/26/2024
Date Signed: 02/26/2024 05:37:16 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
02/23/2024 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20240223111043
FACILITY NAME:AVANI HOMEFACILITY NUMBER:
198603471
ADMINISTRATOR:BUNDI NYAGAFACILITY TYPE:
735
ADDRESS:340 N WESTRIDGE AVETELEPHONE:
(626) 699-2138
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:4CENSUS: 3DATE:
02/26/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Bundi Nyaga, administratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff hit resident with an open hand on the backside of resident's head.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met with Bundi Nyaga, administrator. LPA explained the purpose of today's visit regarding the above-mentioned allegation.

Investigation consisted of the following:
LPA interviewed staff from staff#1 (S1) through staff#4 (S4); inteviewed client#1 (C1); attempted to interview clients from client#2 (C2) through client #4 (C4); reviewed client#1’s record reviews, and a facility tour. LPA obtained copies of the staff and client rosters, client#1’s files and documents with relevant information.

In regard of the allegation: staff hit resident with an open hand on the backside of resident's head, it was alleged that staff#1 (S1) hit client#1 (C1) on the backside of C1’s head with an open hand and staff#2 (S2) did not intervene as S2 was present during the incident.

(-continued in LIC 9099 C-)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
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-20240223111043
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: AVANI HOME
FACILITY NUMBER: 198603471
VISIT DATE: 02/26/2024
NARRATIVE
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The investigation revealed the following:

Per client interviews, C1 stated staff did not hit client. LPA attempted but failed to interview C2 to C4. Client interviews revealed staff did not hit clients. Per staff interviews, all four (4) staff who were interviewed denied the allegation. Staff interviews revealed facility had a zero tolerance policy on staff on hitting clients. They had service training to ensure clients’ right. Administrator took staff#1 (S1) off work schedule after regional center made administrator aware of this allegation.

During the visit, LPA observed staff were nice to clients. Therefore, there is not preponderance evidence to prove the facility staff hit clients while in care at the facility.

Based on the information obtained during the investigation, interviews with staff, clients, review of client files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

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

An exit interview was conducted and the finding was discussed. A copy this report was provided to administrator at time of visit.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Bonnie Tao
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2