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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603677
Report Date: 10/29/2024
Date Signed: 10/29/2024 10:30:03 AM

Document Has Been Signed on 10/29/2024 10:30 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 PROGRAMFACILITY NUMBER:
198603677
ADMINISTRATOR/
DIRECTOR:		NWADIKE, VIOLAFACILITY TYPE:
775
ADDRESS:12510 E. SLAUSON AVE UNIT I&HTELEPHONE:
(818) 274-1809
CITY:SANTA FE SPRINGSSTATE: CAZIP CODE:
90670
CAPACITY: 90CENSUS: 20DATE:
10/29/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Uche Chikwendu, SupervisorTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Cynthia Chan and Luis DeLeon conducted a case management visit to issue additional deficiencies found during a complaint investigation. LPAs arrived unannounced and met with Staff Uche Chikwendu. The reason for the visit was explained.

On 8/8/24, LPA Chan conducted a complaint investigation. LPA obtained a video footage that showed Staff #1 (S1) dragging Client #1 (C1) from the alleyway back to the facility. It was determined that S1 did not use the appropriate CPI techniques to handle the behavior. The program administrator also acknowledged the incident was not documented or reported to Community Care Licensing and other appropriate agencies.


Deficiencies are noted on LIC 809D per Title 22 regulations.

Exit interview was conducted with Mr. Chikwendu. A copy of this report and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/29/2024 10:30 AM - It Cannot Be Edited


Created By: Cynthia D Chan On 10/29/2024 at 09:32 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 10/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/30/2024
Section Cited
CCR
82065(a)

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82065 Personnel Requirements (a) Program personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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The licensee shall ensure Staff #1 is provided the proper training to handle client's behaviors. This training log shall be submitted to LPA by 10/30/24.
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Based on interviews and record review, Staff #1 did not have the competency to provide the services necessary to meet the client’s needs which posed an immediate health, safety, and personal rights risk to clients in care.
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Type B
11/05/2024
Section Cited
CCR82061(a)

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82061 Reporting Requirements (a) Upon the occurrence... any of the events specified in Section 82061(a)(1), a report shall be made to the licensing agency within...seven days following the occurrence of the event.
This requirement is not met evidenced by:
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The licensee shall provide a written statement indicating that incidents will be reported timely to the appropriate agencies by POC due date 11/5/24.
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Based on interview, the administrator did not report the incident to the appropriate agencies which poses a potential health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tony Vasallo
LICENSING EVALUATOR NAME:Cynthia D Chan
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
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