198601265-8-2-2024-28-AS-RORN-D7XKL9-20240808075930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601265
Report Date: 08/02/2024
Date Signed: 08/02/2024 03:32:37 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
07/26/2024 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240726152603

FACILITY NAME:	INSIGHT FOR LIFE		FACILITY NUMBER:	198601265
ADMINISTRATOR:	JESSICA MONZON		FACILITY TYPE:	735
ADDRESS:	606 N. LEAF AVE		TELEPHONE:	(626) 339-1016
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	4	CENSUS: 3	DATE:	08/02/2024
		UNANNOUNCED	TIME BEGAN:	10:29 AM
MET WITH:	Area Manager Roger Escorcia		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff physically abused resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 08/02/2024 regarding the above allegation. LPA Ramirez was met by Direct Support Staff (DSP) Sylvia Mendoza. Area manager Roger Escorcia arrived shortly after to assist with tour.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 3 interviews (S1 – S3), Interview of Clients# 2 & 3 (C2-C3), Attempted interview of Clients#1, 4 (C1, C4), Interview of Detective Casa-West Covina Police Department, Copy of West Covina Police Report 24-04416, copies of Client#1 (C1) Physician’s Report, Identification and Emergency Information form, Admission Agreement, San Gabriel/ Pomona Regional Center Individual Program Plan (IPP), and physical plant tour.

SEE 9099- C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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-20240726152603

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: INSIGHT FOR LIFE	FACILITY NUMBER: 198601265
	VISIT DATE: 08/02/2024

NARRATIVE

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The investigation revealed the following. Regarding Allegation: Staff physically abused resident in care- It is alleged on 7/26/2024, facility staff pulled, pushed and scratched C1 while C1 was using their cellphone. Three (3) out of the three (3) staff interviewed deny this allegation. Two (2) out of the two (2) clients interviewed deny this allegation. Due to C4 being limited verbal, LPA Ramirez was unable to interview C4. C1 has relocated and has not returmed to the facility since 7/26/24. LPA Ramirez was unable to interview C1 during visit. Interview of Detective Casa did not corroborate this allegation and revealed the case has been closed due to the allegation being unfounded. LPA Ramirez reviewed West Covina Police Report 24-04416 and it revealed that on 7/26/2024, when police arrived to interview C1, no obvious injuries were noted on C1 due to the alleged incident. LPA Ramirez reviewed C1’s IPP and it revealed C1 has a history of making false accusations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were observed during this investigation. Exit interview conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 981-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC9099 (FAS) - (06/04)

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