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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 05/17/2024
Date Signed: 05/17/2024 01:43:14 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
04/12/2024 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240412114855
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:
05/17/2024
UNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Administrator Mellad FalatoonzadehTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Client sexually assaulted while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 05/17/2024, to deliver findings. Health and Safety check was conducted on 04/15/2024 by LPA Ramirez and needs further investigation was documented. LPA Ramirez was met by Administrator Mellad Falatoonzadeh and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), Client Roster, LPA Ramirez interview of Staff#1-3 (S1-S3), LPA Ramirez interview of Clients #2 interviews C2, Interview of Client#1 (C1) by Investigator Ferris, Copies of client#1- 3 (C1-C3): Physician’s report, face sheet, Unusual Incident Report (LIC 624), Admission Agreement, Individual Program Plan (IPP) dated 10/17/2022, facility body check form dated 03/22/2024 through 03/31/2024, Individual Behavior Supports Plan (IBSP) dated 04/09/2024, and other pertinent documents regarding this investigation and physical plant tour.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
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-20240412114855
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: INSIGHT FOR LIFE EBSH @ GIANO
FACILITY NUMBER: 198603490
VISIT DATE: 05/17/2024
NARRATIVE
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Client sexually assaulted while in care- It is alleged that facility staff sexually assaulted C1 while in care. Three (3) out of the three (3) staff LPA Ramirez interviewed, denied this allegation. One (1) out of the one (1) client LPA Ramirez interviewed, denied this allegation. Interview conducted by Investigator Ferris revealed C2 denied this allegation. LPA Ramirez reviewed Individual Program Plan (IPP) dated 10/17/2022 and it was revealed C1 has a history of fabricating stories. Review of facility body check form dated 03/22/2024 through 03/31/2024, revealed staff did not observe any new marks or injuries to C1. LPA Ramirez reviewed Individual Behavior Supports Plan (IBSP) dated 04/09/2024 and it was revealed C1 has a history of fabricating stories. LPA Ramirez reviewed three (3) personnel records (S1-S3). LPA Ramirez did not observe any discrepancies during record review. Although the allegation 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.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2