198603677-8-8-2024-28-AS-TVAO-D8AU28-20240819151131

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603677
Report Date: 08/08/2024
Date Signed: 08/08/2024 05:54:26 PM

Substantiated

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
07/31/2024 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240731103113

FACILITY NAME:	MILESTONES BEHAVIORAL AND TREATMENT PROGRAM		FACILITY NUMBER:	198603677
ADMINISTRATOR:	NWADIKE, VIOLA		FACILITY TYPE:	775
ADDRESS:	12510 E. SLAUSON AVE UNIT I&H		TELEPHONE:	(818) 274-1809
CITY:	SANTA FE SPRINGS	STATE: CA	ZIP CODE:	90670
CAPACITY:	90	CENSUS: 14	DATE:	08/08/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Uche Chikwendu, Supervisor		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff handled client in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Supervisor, Uche Chikwendu. The purpose of the visit was explained.

LPA toured the facility and interviewed the administrator and 4 Staff. LPA also obtained a copy of the staff roster, client roster, staff in-service training logs, and reviewed Client #1’s Behavioral Support Plan. Interviews with clients were attempted but unsuccessful due to their cognitive abilities.

The allegation of staff handled client in a rough manner. It was alleged that a staff dragged Client #1 (C-1) to return to the facility. The administrator acknowledged that an incident occurred on 7/30/24 during a fire drill. C-1 went next door instead of going back to the facility.

Substantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

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-20240731103113

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: MILESTONES BEHAVIORAL AND TREATMENT PROGRAM	FACILITY NUMBER: 198603677
	VISIT DATE: 08/08/2024

NARRATIVE

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The administrator explained that the business next door had just finished spraying a car and the fume was toxic. Multiple staff attempted to redirect C-1 from the building to get away from the fume. Since redirection was not successful and staff felt the urgency to remove client from the setting, it resulted in several staff carrying C-1 toward their day program. It was also noted that C-1 was resistive and combative while a staff was lifting the client, which made staff having to use a little more force to handle client. No bruises or injuries were noted when the incident occurred. Staff acknowledged C-1 likes going next door when client gets the chance and is able to redirect back to the facility on most occasions. They indicated they have CPI training and do not use restraints on the clients. They stated verbal redirection is normally used and have not utilized any restraints on clients. LPA interviewed an individual who witnessed a staff handling the client roughly during the incident that took place on 7/30/24.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 3), are being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Correction was reviewed and developed with the administrator via telephone. A copy of this report and appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240731103113

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: MILESTONES BEHAVIORAL AND TREATMENT PROGRAM	FACILITY NUMBER: 198603677
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/15/2024 Section Cited CCR 82065(f)	1 2 3 4 5 6 7	82065 Personnel Requirements (f) All personnel shall be given on-the-job training or shall have related experience providing knowledge of and skill in the following areas,.. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The licensee shall conduct an in-service training to outline the approved procedures if redirection is not effective with a client. The log along with the plan shall be submitted to LPA by 8/15/24.
	8 9 10 11 12 13 14	Based on interviews conducted, a staff handled the client in a rough manner which poses a potential health, safety, and personal rights risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024

LIC9099 (FAS) - (06/04)

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