198603490-9-23-2025-28-AS-FFIS-DMR25G-20251023170528

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 09/23/2025
Date Signed: 09/23/2025 12:51:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
09/16/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250916103756

FACILITY NAME:	INSIGHT FOR LIFE EBSH @ GIANO		FACILITY NUMBER:	198603490
ADMINISTRATOR:	FALATOONZADEH, MELLAD		FACILITY TYPE:	737
ADDRESS:	601 GIANO AVE		TELEPHONE:	(626) 295-2535
CITY:	LA PUENTE	STATE: CA	ZIP CODE:	91744
CAPACITY:	4	CENSUS: 3	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Mellad Falatoonzadeh, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff caused injury to client while in care.
Staff handled client in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with the Administrator, Mellad Falatoonzadeh. The purpose of the visit was explained.

LPA obtained copies of the staff roster, client roster, and documentation for Client #1 (C1).
LPA toured the facility and interviewed Staff #1 - #6 and Clients #1-#2.

The investigation revealed the following:
Allegation - Staff caused injury to the client while in care. It is alleged that Client #1 (C1) sustained a bruise on the back. LPA interviewed six (6) staff during the visit today. All the staff stated that they perform body checks on the clients twice a day. The bruise on C1’s back was first noted on 7/9/25 and documented on a body check form.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

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-20250916103756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: INSIGHT FOR LIFE EBSH @ GIANO	FACILITY NUMBER: 198603490
	VISIT DATE: 09/23/2025

NARRATIVE

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Per document review, C1 had a behavior and threw himself/herself on the concrete, causing scrapes and redness to the mid and lower back. Staff stated that the mark on the back was continuing to be monitored and noted on the body check forms as a previous SIB (self-injurious behavior) since July. Additionally, any new marks observed are noted on the body check forms. Staff stated that the law enforcement officers had conducted a welfare check on 9/15/25 regarding this allegation and reviewed the body check forms. The officers did not observe any bruises on C1’s back. LPA interviewed two (2) clients, who stated they like living at the facility and that staff take good care of them. C1 stated that the staff did not cause any harm to them. Based on the information gathered, there is no supporting evidence to prove that the staff cause the injury to the client.

Allegation - Staff handled the client in a rough manner. It is alleged that a staff member tried to drown Client #1 (C1) by taking the client into the shower, pulling the jacket over the mouth, and pouring water over the client’s head. LPA interviewed the alleged staff, who denied this allegation. Staff also stated that the police officers had interviewed the staff when they visited the facility on 9/15/25. Other staff interviewed stated that C1 has a history of making false statements and that C1 made this allegation because the client wanted to spend more time with the family. Staff stated they are mandated reporters and will report if they observe any staff being rough with clients. LPA interviewed C1 at the facility. C1 told LPA that he/she lied about the allegation and that none of the staff had been rough or tried to drown him/her. LPA toured the facility’s bathroom. LPA did not observe any bathtubs or stoppers on drainage where possible drowning may occur.

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.

An exit interview was conducted with the administrator. A copy of this report, along with the appeal rights, was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC9099 (FAS) - (06/04)

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