198603650-12-21-2023-28-AS-RORN-CZ4SUE-20240102131103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603650
Report Date: 12/21/2023
Date Signed: 12/21/2023 04:01:54 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
09/01/2023 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230901155359

FACILITY NAME:	DIGNITY HOME CENTER INC. II		FACILITY NUMBER:	198603650
ADMINISTRATOR:	DUROMOLA, ADEBOWALE EVELYN		FACILITY TYPE:	735
ADDRESS:	211 S LARK ELLEN AVE		TELEPHONE:	(626) 922-3944
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	4	CENSUS: 4	DATE:	12/21/2023
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	DUROMOLA, ADEBOWALE EVELYN		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff used profanity towards resident
Staff do not treat resident with respect
Staff hit resident with broom handle

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

***This report supersedes the previous complaint report dated 9/8/23. The reason it’s being superseded is to provide additional information not included on the original LIC9099 dated 9/8/23 and to clarify the finding. The Unsubstantiated Finding will remain the same**

Licensing Program Analyst (LPA) Wong conducted an initial 10 day complaint visit” to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with DSP Magdalene Okosi who allowed the entry of the facility and explained the reason of the visit and assisted LPA with the visit.

The investigation consisted of the following: On today's date, LPA interviewed three clients (C2-C4) and two staff (S2-S3) in the facility and Client#1 (C1), Staff#1 (S1) and administrator via telephone. LPA also reviewed Cl's files and obtained a copy of C1's face sheet, Individual Program Plan (IPP) and Behavioral Quarterly report. (See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

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 2

Control Number 28-AS-20230901155359

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: DIGNITY HOME CENTER INC. II	FACILITY NUMBER: 198603650
	VISIT DATE: 12/21/2023

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 revealed the following: Allegation#1 "Staff used profanity towards resident" LPA interviewed four clients and three out of four clients denied the allegation and reported staff never cursed at them or used any profanity words to them. They reported clients usually did that to staff. LPA interviewed staff and all denied the allegation. Staff interviewed reported that they have all received training and are not able to talk back to the clients even if the clients scream and yell at the staff. Staff interviewed indicated that they will only try to redirect and calm the clients down.

Allegation#2 "Staff do not treat resident with respect” LPA interviewed four clients and three out of four clients denied the allegation and reported all the staff are very nice. No staff ever disrespect them. Clients interviewed indicated that everyone is respectful. LPA interviewed staff and all denied the allegation and reported they would never be disrespectful to the clients. The administrator reported that all the staff are professional, and they would never insult the clients.

Allegation#3 "Staff hit resident with broom handle" LPA interviewed four clients and three out of four clients denied the allegation and reported no staff ever hit any client with the broom handle. Three out of four clients witnessed C1 not listening to the staff as S1 was instructing C1 not to walk on the wet area. Clients interviewed indicated that Staff never hit C1. LPA interviewed staff and staff all denied the allegation. Staff stated that no staff ever hit any client in the facility. Staff indicated that they would never do that to any client. Staff stated clients will try to hit the staff, but staff will not hit the clients.

Based on the interviews conducted with staff and clients and documents reviewed, the 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 allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided to Administrator DUROMOLA, ADEBOWALE EVELYN

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Christine Wong
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 12/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2