374602610-9-30-2021-08-AS-JRAE-C7D3LB-20210930182027

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602610
Report Date: 09/30/2021
Date Signed: 09/30/2021 04:29:11 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/04/2019 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20191204154459

FACILITY NAME:	INNOVATIVE CENTER		FACILITY NUMBER:	374602610
ADMINISTRATOR:	RONALD FABIAN		FACILITY TYPE:	775
ADDRESS:	7464 UNIVERSITY AVENUE		TELEPHONE:	(619) 461-0914
CITY:	LA MESA	STATE: CA	ZIP CODE:	91941
CAPACITY:	60	CENSUS: 24	DATE:	09/30/2021
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Assistant Administrator Cynthia Sison		TIME COMPLETED:	02:54 PM

ALLEGATION(S):

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Lack of supervision resulting in unexplained injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to conclude investigation and deliver findings for the above allegation. LPA Serrano was greeted by Assistant Administrator (AA) Cynthia Sison. LPA identified himself and met with AA Cynthia Sison and discussed the purpose of the visit.

It was alleged that on 12/2/19 Day-Program staff failed to supervise client resulting in unexplained injury. The Department’s investigation included multiple interviews and records review, including medical records.

Interview with Program Director (PD) revealed that the incident was a result of Client 1 (C1) standing up in the classroom and immediately falling before the staff member sitting beside C1 could react. PD denied any neglect by staff. Interview with staff member 1 (SM1) revealed that a staff member was always assigned to C1 to monitor and assist, since C1 was very impulsive and would stand and sit at will. Interview with staff member 2 (SM2) revealed she was sitting near C1 and feeding another client when C1 stood up and fell within seconds.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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 08-AS-20191204154459

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: INNOVATIVE CENTER	FACILITY NUMBER: 374602610
	VISIT DATE: 09/30/2021

NARRATIVE

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During an interview with Client 2 (C2), C2 recalled C1 liking to stand up and sit down often. C2 witnessed C1 fall “a couple of times” but did not witness the December 2, 2019, incident. An Interview was conducted with Client 3 (C3) and it was revealed that C1 and C3 lived at the same group home in the past. C3 said that C1 would often stand up and fall at the group home. The Department attempted an interview with C1 but due to the client’s cognitive impairment, C1 was not deemed a credible witness.

A review of unusual incident reports obtained in the facility file do not show any incidents involving C1 except for one dated 12/2/15 involving C1 possibly having a seizure and emergency services were immediately called.

A review of the client's Individual Program Plan (IPP) indicates that C1 requires staff to be around when walking due to C1’s unsteady gait, compromised vision and dementia which could result in falls. C1’s Physician’s Report indicates a primary diagnosis of dementia and a secondary diagnosis of intellectual disability. A review of records revealed C1 sustained multiple facial fractures as a result of the fall in question.

Interview with outside source agency (OSA) confirmed that C1 is ambulatory to some extent but requires one on one assistance when walking with a walker also C1 can be non-compliant. OSA stated they have never had an issue with Innovative Center and felt that they were doing a great job.

Due to the client’s propensity to stand up without warning and non-compliant nature, it could not reasonably be attributed to the lack of supervision that C1 fell and sustained injuries.

Based on interviews and review of documentation, the findings were established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the violation occurred. An exit interview was conducted with Assistant Administrator Cynthia Sison to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 01/16) were provided via E-mail.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC9099 (FAS) - (06/04)

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