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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603490
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:23:18 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
11/30/2023 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20231130112734
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:
12/07/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Mellad FalatoonzadehTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Facility staff mismanaged residents' medications.
Facility staff did not allow residents optional food choices out of the menu.
Facility staff disclosed residents' information to other residents as a form of intimidation.
Facility staff made inappropriate comments to the resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegations above. LPA met with Administrator Mellad Falatoonzadeh and explained the purpose of the visit.

LPA conducted the following on todays visit: Interviewed Staff #1-#7 (S1-S7), Clients #1-#3 (C1-C3), toured the physical plant, and reviewed medication for C1-C3. LPA reviewed and collected copies of the food menu, staff/client roster, C1-C3's Facesheet, physicians report, and medication records for the months of July 2023-September 2023. The investigation revealed the following:

In regards to the allegation "Facility staff mismanaged residents' medications" it was alleged that staff demonstrated gross negligence when presented medication administration errors. (7) of (7) Staff interviewed denied the allegation. (3) of (3) Clients interviewed could not corroborate the allegation...

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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-20231130112734
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: 12/07/2023
NARRATIVE
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File review does not show medications errors from the month of July 2023 to current month. Interviews do not state that there have been medication errors in the facility. Clients interviews stated they take their medications and have no problems. Based on interviews conducted, LPA observations, and file review there was not enough supportive evidence to concur with the reported allegation. 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.

In regards to the allegation "Facility staff did not allow residents optional food choices out of the menu" it was alleged that staff only let clients eat meals that are on the food menu and not allow optional meals. (7) of (7) Staff interviewed denied the allegation. (3) of (3) Clients interviews could not corroborate the allegation. Interviews with staff show that there are various way in which clients are offered alternate meals if they express not wanting what is on the menu. Staff stated they will prepare other meals or make changes to the meals made when requested. C1 has their own meal schedule due to their health condition and other clients can also follow that meal schedule if they choose. Interviews do not show that clients are forced to only eat what is on the menu. Based on interviews conducted, LPA observations, and file review there was not enough supportive evidence to concur with the reported allegation. 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.

In regards to the allegation "Facility staff disclosed residents' information to other residents as a form of intimidation" it was alleged that staff disclose information about incoming clients to current clients as a mode to intimidate them for compliant behavior. (7) of (7) Staff interviewed denied the allegation. (3) of (3) Clients interviewed could not corroborate the allegation. LPA was not provided with specific examples. Interviews do not show that staff will disclose a clients personal information to any other clients. Interviews do not show that staff will attempt to intimidate clients in care. LPA did not observe staff to attempt to intimidate clients in care during the visit. Based on interviews conducted, LPA observations, and file review there was not enough supportive evidence to concur with the reported allegation. 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.

Continued on LIC 9099-C
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20231130112734
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: 12/07/2023
NARRATIVE
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In regards to the allegation "Facility staff made inappropriate comments to the resident" it was alleged that Staff will remind clients that previous staff are no longer there because of them. (7) of (7) Staff interviewed denied the allegation. (3) of (3) Clients interviewed could not corroborate the allegation. Interviews do not show that staff speak inappropriately to clients in care. LPA did not observe staff speaking inappropriately to clients in care during the visit. LPA was not provided with proof that staff make inappropriate comments to clients in care. Based on interviews conducted, LPA observations, and file review there was not enough supportive evidence to concur with the reported allegation. 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 and a copy of this report was provided.
NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3