198603490-8-7-2023-28-AS-FFIS-CUPPZR-20230814114555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 08/07/2023
Date Signed: 08/07/2023 11:52:03 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
08/25/2022 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220825150657

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:	08/07/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Mellad Falatoonzadeh (Administrator)		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff hit resident.
Staff did not assist resident with obtaining medical treatment.
Staff do not report incidents to appropriate parties.
Staff speak inappropriately to residents.
Facility does not meet residents' dietary needs.

INVESTIGATION FINDINGS:

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

During the initial visit on 08/26/22, LPA obtained a copy of the Staff schedule/Client roster and toured the facility. The facility was observed to be clean and in good repair. LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Restrooms, handwashing basins, toilets and bathtub/showers are operable. There were no immediate health and safety concerns during the visit.

During today's visit, LPA obtained a copy of the Staff/Client rosters, toured to kitchen with Staff #1, interview Staff #1 to #6 in the garage/office, attempted to interview Client #1 and interviewed Client #2 in bedroom #4. 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: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

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-20220825150657

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: 08/07/2023

NARRATIVE

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In regards to the allegation: Staff hit resident. Interviews with 6 of 6 Staff denied ever hitting a Client and never witnessed other Staff hit a Client. Interview with 1 of 1 Client indicate Staff never hit them and never witnessed Staff hit other Clients.

In regards to the allegation: Staff did not assist resident with obtaining medical treatment. Interviews with 6 of 6 Staff indicate they assist with obtaining medical treatment for a Client when needed. Interview with 1 of 1 Client indicate Staff assist with obtaining medical treatment when needed.

In regards to the allegation: Staff do not report incidents to appropriate parties. Interviews with 6 of 6 Staff indicate incidents are reported. LPA's review of facility incident reporting history also indicate incidents are reported to the department.

In regards to the allegation: Staff speak inappropriately to residents. Interviews with 6 of 6 Staff indicate they have never spoken inappropriately to Clients nor have they witnessed other Staff speaking to Clients inappropriately. Interview with 1 of 1 Client indicate Staff has never spoken to Clients inappropriately.

In regards to the allegation: Facility does not meet residents' dietary needs. Per allegation details, facility does not provide juice and snacks to Clients. LPA toured the kitchen and observed an abundant amount of snacks and juice available to Clients. Interviews with 6 of 6 Staff indicate snacks and juice are provided to Clients. Interview with 1 of 1 Client also indicate juice and snacks are provided to Clients.

Based on LPA's record review, observations and 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 with Mellad Falatoonzadeh (Administrator) and a copy of this report provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Kruz Long
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023

LIC9099 (FAS) - (06/04)

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