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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603658
Report Date: 08/15/2024
Date Signed: 08/15/2024 03:21:48 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
08/07/2024 and conducted by Evaluator Alberto Lopez
COMPLAINT CONTROL NUMBER: 28-AS-20240807131504
FACILITY NAME:DIGNITY HOME CENTER INCFACILITY NUMBER:
198603658
ADMINISTRATOR:DUROMOLA, ADEBOWALE EVELYNFACILITY TYPE:
735
ADDRESS:230 E BENWOOD STTELEPHONE:
(626) 922-3944
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY:6CENSUS: 6DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Nike Aralepo, DSP and Evelyn Duromola, AdministratorTIME COMPLETED:
03:39 PM
ALLEGATION(S):
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Staff hit resident.
Staff did not comply with reporting requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lopez conducted an Initial 10-Day complaint investigation regarding the above allegations. LPA was greeted by Nike Aralepo, DSP and LPA discussed the purpose if the visit. Administrator arrived a short time later and assisted with visit.

Investigation consisted of the following: interview of Staff #1 - Staff #4 (S1-S4); interviews of clients from client#1 through client #6 (C1-C6); reviewed and obtained copies of client #1 (C1) relevant records, and a facility tour. LPA obtained copies of the staff and client rosters.

The investigation revealed the following:
For the allegation of: Staff hit resident. It is alleged that staff hit C1 in the right eye causing a bruise.
LPA interviewed four (4) staff including administrator and all four (4) staff denied the allegation. LPA interviewed six (6) clients and five (5) of six (6) clients could not collaborate the allegations. C1 did not want to answer questions regarding the allegation.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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 2
Control Number 28-AS-20240807131504
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
FACILITY NUMBER: 198603658
VISIT DATE: 08/15/2024
NARRATIVE
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C1 has a history of fibbing and it is documented in C1 last IPP. The photos provided did not show any evidence of bruising around the eye. Staff stated that the darkness around C1 eyes is skin condition, not bruise. Current photo showed the same darkness around C1 eye 11 days after alleged incident. S3 denied hitting client and stated S3 has never hit a client. There is not enough evidence to substantiate this allegation.

Allegation: Staff did not comply with reporting requirements. It is alleged that facility did not report incident within required time frame. LPA interviewed four (4) staff and three (3) of four (4) staff could not comment about this and stated they did not know if it was reported. S4 (administrator) stated that she just learned about this incident this week on August 13th and will send incident report today. Administrator provided documentation to LPA to proof she had just learned of incident on Tuesday August 13th 2024 when Regional Center QA called facility to report incident. The facility reported the incident within the time frame allowed. There in no evidence that facility failed to report incident within the required time.

Based on the information obtained during the investigation, interviews with staff, clients, review of client files and LPA's observation, the investigation did not reveal any evidence to support the allegations mentioned above.

Although the allegations may have happened or are valid, there is not preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is UNSUBSTANTIATED.

Exit interview conducted with Evelyn, administrator. A copy of this report were provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2