374603103-5-18-2022-08-AS-IESA-CEYR23-20220601123737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603103
Report Date: 05/18/2022
Date Signed: 05/18/2022 09:55:48 AM

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
02/28/2020 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20200228133929

FACILITY NAME:	ADVANTAGE CENTER, THE		FACILITY NUMBER:	374603103
ADMINISTRATOR:	DARIUSH RAZAVI		FACILITY TYPE:	775
ADDRESS:	8363 CENTER DR UNIT 4		TELEPHONE:	(619) 697-6311
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	75	CENSUS: 71	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Assistant Director Felise Dulay		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Lack of supervision, resulting in client injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit, to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and explained the purpose of the visit to Assistant Director Felise Dulay.

It was alleged that in late January 2020, Client #1 (C1) suffered a right elbow fracture. It was also alleged the injury was discovered upon C1’s return to the group home where they live, and that C1 said they fell while attending day program with licensee. CDSS’ investigation consisted of an unannounced facility tour/welfare check, review of C1’s care and medical records, and interviews of pertinent day program staff, group home staff, and outside sources.

[CONTINUED ON LIC 9099-C, 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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 3

Control Number 08-AS-20200228133929

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: ADVANTAGE CENTER, THE	FACILITY NUMBER: 374603103
	VISIT DATE: 05/18/2022

NARRATIVE

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[CONTINUED FROM LIC 9099]

The Department’s investigation revealed that on January 30, 2020, C1 indeed returned home complaining of new wrist pain (i.e., pain which was not present when they left for day program earlier that morning). X-rays taken that same evening revealed a “focal tiny chip fracture to the scaphoid bone” of C1’s right wrist (and not their elbow). C1 was subsequently seen by an orthopedist and prescribed a fiberglass cast to wear.

Two instructional staff closely supervised C1 for the duration of their attendance at program on the date in question; both corroborated C1 did not fall, and C1’s hand/wrist/arm did not hit a hard object. Both witnessed C1 complete physical therapy (which involved pulling on elastic exercise bands), plus an hour-long computer lab class (which involved hand motor skills). They also helped C1 to the restroom multiple times (which involved C1 grabbing onto staff members’ elbows while transferring up from the toilet seat). In each of the above activities, C1 exhibited no pain, difficulty, or sign of injury. Two transportation staff (not associated to the facility) closely supervised C1 as they transited to and from day program on the date in question; both corroborated that C1 did not fall, and C1’s hand/wrist/arm did not hit a hard object. Boarding of the vehicle involved grabbing onto handrails while climbing a few steps, which C1 did without pain, difficulty, or sign of injury.

When interviewed by CDSS about their wrist injury, C1 gave two different explanations, neither of which matched their initial claim that they fell at day program. [A caregiver at the group home said they too asked C1 about their wrist injury and received a third different explanation, which also did not match C1 falling at day program.] Day program staff, group home staff, and medical staff assigned to C1 unanimously reported that C1 is not a reliable historian. The Department encountered no evidence to corroborate that C1 ever fell at the day program (i.e., while in licensee’s custody).

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20200228133929

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: ADVANTAGE CENTER, THE	FACILITY NUMBER: 374603103
	VISIT DATE: 05/18/2022

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[CONTINUED FROM LIC 9099-C, 1 of 2]

According to day program records, group home records, and medical records on C1: in the six months preceding the wrist injury, C1 developed signs of early dementia and insomnia, which a psychiatrist and a neurologist were treating with medication. During this time, C1 had new outbursts of frustration, to include striking themselves, walls, tables, and other objects. Interviews of 3 of 3 leaders of the group home revealed that a few nights prior to the date of the incident in question, staff witnessed C1 wake up agitated and repeatedly hit the wall of their bedroom with their hands and arms. Internal progress notes from the group home revealed: a) On January 27, 2020, C1 was awake the entire nocturnal shift, at times hitting themselves and “yelling cusswords”; and b) On January 29, 2020, C1 was awake all night talking to themselves, hitting themselves, hitting the wall, and yelling “No!” and curse words. According to C1’s treating orthopedist, the chip to C1’s scaphoid bone “could have happened by [them] striking the wall and it later became irritated causing swelling and pain,” just as much as it could have been from a fall in which C1 tried to catch themselves.

Based on interviews and review of care and medical records, a preponderance of evidence does not exist to support the allegation that licensee’s lack of supervision resulted in C1 suffering their wrist injury. The allegation is therefore unsubstantiated. An exit interview was conducted with Dulay. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to Dulay. A duplicate set of these documents was E-mailed to Administrator/Director Ray Pallasigue.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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