198603490-6-22-2023-28-AS-FFIS-CT42Q9-20230623173535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 06/22/2023
Date Signed: 06/22/2023 11:01:35 AM

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
10/28/2022 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221028082140

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: 2	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Mellad Falatoonzadeh (Administrator)		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff forced client to take medication.
Staff handled resident in a physically rough manner.
Licensee encourages staff to make false statements to licensing.
Facility does not have adequate staffing.

INVESTIGATION FINDINGS:

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***This licensing report LIC9099 supersedes LIC9099 dated 11/01/22.***

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint investigation at the facility. Upon arrival, LPA met with Mellad Falatoonzadeh (Administrator) and explained the purpose of the visit.

During the initial visit conducted on 11/01/22, LPA obtained a copy of the Staff schedule/Client rosters and interviewed Staff #1 in the garage/office, interviewed Staff #2 to #4 in the sensory room, interviewed Client #2 in the backyard and attempted to interview Client #1 in the dining area.

During today's visit, LPA obtained a copy of the Staff schedule/Client roster and interviewed Staff #5 and #6 via telephone in the garage/office. LPA attempted to interview Client #1. Continue to LIC9099C....

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

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-20221028082140

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: INSIGHT FOR LIFE EBSH @ GIANO	FACILITY NUMBER: 198603490
	VISIT DATE: 06/22/2023

NARRATIVE

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***This licensing report LIC9099C supersedes LIC9099C dated 11/01/22.***

In regards to the allegation: Staff forced client to take medication. Interviews with 6 of 6 Staff indicate they have never forced a Client to take medication nor have they witnessed other Staff force Clients to take their medication. Interview with Client #2 indicate Staff have never forced them to take medication nor has Client #2 witnessed Staff forced medication on Clients.

In regards to the allegation: Staff handled resident in a physically rough manner. Interviews with 6 of 6 Staff indicate they have never handled a Client in a physically rough manner nor have they witnessed other Staff handle Clients in a physically rough manner. Interview with Client #2 indicate Staff have never handled Client #2 in a physically rough manner nor have Client #2 ever witnessed Staff handle Clients in a physically rough manner.

In regards to the allegation: Licensee encourages staff to make false statements to licensing. Interviews with 6 of 6 Staff indicate they have never been encouraged by the Licensees or Administrators to make false statements to Licensing.

In regards to the allegation: Facility does not have adequate staffing. Review of the Staff schedules obtained on 11/01/22 and on 06/22/23 indicate Staffing is adequate.

Based on LPA's interviews, the investigation revealed: Although the allegations may have happened or is 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 and a copy of this report provided to Mellad Falatoonzadeh.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023

LIC9099 (FAS) - (06/04)

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