<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 04/15/2024
Date Signed: 04/15/2024 02:59:38 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
03/29/2024 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20240329124327
FACILITY NAME:INSIGHT FOR LIFE EBSH @ GIANOFACILITY NUMBER:
198603490
ADMINISTRATOR:FALATOONZADEH, MELLADFACILITY TYPE:
737
ADDRESS:601 GIANO AVETELEPHONE:
(626) 295-2535
CITY:LA PUENTESTATE: CAZIP CODE:
91744
CAPACITY:4CENSUS: 3DATE:
04/15/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Mellad FalatoonzadehTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained multiple injuries due to staff neglect
Staff handled resident in a rough manner
Staff threatened resident
Staff are not properly trained
Staff did not safeguard resident's personal belongings
Staff do not allow residents to go on outings
Staff do not allow residents to purchase personal items
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/15/2024 at 8:45 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit regarding the above allegations. The purpose of the visit was explained to Administrator Mellad Falatoonzadeh.

During the visit on 4/4/2024 LPA conducted a physical plant tour with the administrator. The following documents were obtained: Staff roster, resident roster, and the last 3 months of client notes (December 2023, January 2024, and February 2024).

Report Continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
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 3
Control Number 28-AS-20240329124327
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: 04/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During todays visit, LPA interviewed the Administrator and a total of 4 staff who shall be referred to as staff#1 through staff #4 (S1-S4). LPA also interviewed at total of 3 clients, who shall be referred to as Client#1 through Client#3 (C1-C3). LPA interviewed C1’s service coordinator, who shall be referred to as Witness#1 (W1). LPA obtained staff trainings, Record of clients/Residents safeguarded cash resources for C2 and C3 (C1 is not receiving P&I), 1 month of client notes, and all clients Individual Program Plan (IPP).

The investigation reveals the following: Regarding “Resident sustained multiple injuries due to staff neglect”. It is alleged that C1 has suffered some bruises on legs from dropping to the ground and from staff trying to pick C1 up. The Administrator denied the allegation stating the clients have a ratio of 1:3, 1:4, and 1:2. The Administrator further stated staff do not physically touch clients during behaviors, unless they are a danger to themselves or others. Whenever C1 drops to the floor, staff uses methods such as laying down a blanket or pillow to help prevent injuries. 4 out of 4 staff denied the allegations stating they have never neglected C1 during their behaviors. Staff further stated they have used pillows, yoga matts, and blankets to keep C1 from harming themselves. 3 out of 3 clients denied the allegation, stating that staff have never hurt them physically. W1 confirmed C1 has behaviors and is on a 1:3 ratio with practically 24-hour care. LPA reviewed C1’s IPP and observed the client has a history of self-injurious behaviors.

The investigation reveals the following: Regarding “Staff handled resident in a rough manner”. It is alleged that staff fling C1. The Administrator denied the allegation stating staff do not physically touch clients during behaviors unless they are a danger to themselves or others. The administrator further stated they have never treated the clients roughly. 4 out of 4 staff denied the allegations stating they have never witness staff treating the clients in a rough manner. 3 out of 3 clients denied the allegation, stating that staff have never hurt or abused them. W1 confirmed that staff have never abuse C1 and they conduct monthly visitation.

The investigation reveals the following: Regarding “Staff threatened resident”. It is alleged that staff threaten C1 with sleeping on the floor if C1 do not put on Pajamas. The Administrator denied the allegation stating staff has never threaten the clients. 4 out of 4 staff denied the allegations stating they have never witness staff threatening the clients. 3 out of 3 clients denied the allegation stating staff has never threaten them. W1 confirmed that staff have never threaten their client and they conduct monthly visitation.

The investigation reveals the following: Regarding “Staff are not properly trained”. It is alleged that some staff are not properly trained. The Administrator denied the allegation stating staff are trained by the facility and behaviorist frequently. 4 out of 4 staff denied the allegation stating they are properly trained. LPA reviewed training for all staff interviewed and confirmed all trainings including the initial 40 hours, continuing education, and valid CPI cards.

The investigation reveals the following: Regarding “Staff did not safeguard resident's personal belongings”. It is alleged that staff snatch a phone number from C2. The Administrator denied knowledge of the incident and stated there is no issues regarding the client’s personal belongings. 4 out of 4 staff denied knowledge of the incident and further stated there is no issues of theft in the home. 3 out of 3 clients denied the allegation and knowledge of the incident. During the tour LPA observed each client’s room is decorated to their preferences. Report continued on 9099c

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240329124327
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: 04/15/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation reveals the following: Regarding “Staff do not allow residents to go on outings”. It is alleged that staff do not take clients on outings. The Administrator denied the allegation stating clients go on outings twice a week depending on behaviors. 4 out of 4 staff stated the clients go on outs 2- 3 times a week. 3 out of 3 clients confirmed they go on outs and expressed their favorite places to visit. W1 stated they were informed the clients go on outing. LPA reviewed 1 month of client notes for each client and observed clients went on outings at least twice a week.

The investigation reveals the following: Regarding “Staff do not allow residents to purchase personal items”. It is alleged that staff do not allow clients to buy what they want. The Administrator denied the allegation stating clients receive P&I and buy personal items on there outings. The administrator further stated C1 has not received P&I since November and the facility has been funding C1’s purchases until the Regional Center clears up the issue. 4 out of 4 staff denied the allegation stating the clients buy whatever they want during their outings. 3 out of 3 clients confirmed they buy whatever they want and showed LPA some of the things they bought. W1 confirmed C1 is having issues with P&I. W1 further stated C1 receives a small stipend, and the facility also assists with finances until the matter is resolved. LPA observed the clients safeguard and cash resources document and observed trips to places such as Walmart and Target. LPA also reviewed client notes and observed outings to purchase personal items.

Based on LPA's interviews, investigation revealed: Although the allegation 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 with Administrator Mellad Falatoonzadeh and a copy of this record provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3