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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601390
Report Date: 05/19/2023
Date Signed: 06/16/2023 02:16:52 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/12/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230512131547
FACILITY NAME:NEW DAY MONTEBELLO WEIGHT MANAGEMENTFACILITY NUMBER:
198601390
ADMINISTRATOR:MATILDAKODJANIANFACILITY TYPE:
775
ADDRESS:511 WASHINGTON BLVD.TELEPHONE:
(323) 726-1444
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:120CENSUS: 45DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Director Matilda Kodjanian TIME COMPLETED:
01:46 PM
ALLEGATION(S):
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Facility does not have sufficient staff to meet the needs of client in care
INVESTIGATION FINDINGS:
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*****This report serves as an amendment and supersedes the original complaint investigation report dated 5/19/2023. The reason for amendment is to make corrections to LIC9099. The investigation findings remain the same.******

On 05/19/2023 at 08:45 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a 10-day complaint visit, to investigate the allegation listed above. LPA met with Director Matilda Kodjanian and explained the reason for the visit.

During the visit, LPA and the Director toured the facility. LPA obtained resident roster, staff roster, staff daily assignments, one on one assignments, Client #1 IPP and Client #2 IPP. LPA also interviewed: Director Matilda Kodjanian and a total of six (6) staff who shall be referred to as: S1 through S6. LPA interviewed a total of 5 clients who shall be referred to as: C1 through C5.
Report continued on 9099c
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
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 5
Control Number 28-AS-20230512131547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NEW DAY MONTEBELLO WEIGHT MANAGEMENT
FACILITY NUMBER: 198601390
VISIT DATE: 05/19/2023
NARRATIVE
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The investigation reveals the following: Regarding " Facility does not have sufficient staff to meet the needs of client in care.", it is alleged that one on one clients wander around the facility unattended because the facility is short staffed. The Director denied the allegation stating the one-to-one clients are always with one care staff. 3 out of the 6 staff interviewed indicated the facility supervisor will leave their one-to-one client with another staff during their lunch break. The staff will now have a total of 2 clients, which is no longer a one to one. 3 out of the 6 staff interviewed denied the allegation stating the facility has never given them additional clients when they have a client who requires one on one supervision. 2 out of 5 clients stated they are never left alone but was not able to communicate if the staff supervising them has an additional client. 3 out of 5 clients do not have one on one supervision.


Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the allegations are found to be Substantiated.

Exit interview held. A copy of the report and appeal rights were provided to Director Matilda Kodjanian.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 28-AS-20230512131547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: NEW DAY MONTEBELLO WEIGHT MANAGEMENT
FACILITY NUMBER: 198601390
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/22/2023
Section Cited
CCR
82065.5(a)(1)
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82065.5 Staff-Client Ratio
(1) For Regional Center clients, staffing shall be maintained as specified by the Regional Center.

This requirement is not met as evidenced by
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Facilty Director agrees to staff training on one-on-one care and to provide a plan that shows one-on-one clients has adequte supervison as required by Regional center. The traing log and plan will be submitted to CCLD by POC due date.
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 Based on observation and interviews, 3 out of 6 staff confirmed facility supervisor provide care staff with an additional one on one client during the supervisors lunch break, which poses an immediate health, safety, or personal rights risk to persons 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: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/12/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230512131547

FACILITY NAME:NEW DAY MONTEBELLO WEIGHT MANAGEMENTFACILITY NUMBER:
198601390
ADMINISTRATOR:MATILDAKODJANIANFACILITY TYPE:
775
ADDRESS:511 WASHINGTON BLVD.TELEPHONE:
(323) 726-1444
CITY:MONTEBELLOSTATE: CAZIP CODE:
90640
CAPACITY:120CENSUS: 45DATE:
05/19/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Director Matilda Kodjanian TIME COMPLETED:
01:46 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Facility does not have proper equipment to provide transfer assistance to clients in care
INVESTIGATION FINDINGS:
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3
4
5
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9
10
11
12
13
*****This report serves as an amendment and supersedes the original complaint investigation report dated 5/19/2023. The reason for amendment is to make corrections to LIC9099A. The investigation findings remain the same.******

On 05/19/2023 at 08:45 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a 10-day complaint visit, to investigate the allegation listed above. LPA met with Director Matilda Kodjanian and explained the reason for the visit.

During the visit, LPA and the Director toured the facility. LPA obtained resident roster, staff roster, staff daily assignments, one on one assignments, Client #1 IPP and Client #2 IPP. LPA also interviewed: Director Matilda Kodjanian and a total of six (6) staff who shall be referred to as: S1 through S6. LPA interviewed a total of 5 clients who shall be referred to as: C1 through C5.
Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 28-AS-20230512131547
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: NEW DAY MONTEBELLO WEIGHT MANAGEMENT
FACILITY NUMBER: 198601390
VISIT DATE: 05/19/2023
NARRATIVE
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The investigation reveals the following: Regarding " Facility does not have proper equipment to provide transfer assistance to clients in care.", it is alleged that facility do not have the necessary equipment to safely transfer wheelchair bound clients. The Director denied the allegation stating the facility requires 2 care staff to assist wheelchair bound clients. 6 out of the 6 staff interviewed denied the allegation, stating the facility provides 2 care staff to assist in wheelchair transfers. 3 out of 5 clients utilizes a wheelchair and confirmed they feel safe during wheelchair transfers. 2 out of 5 clients do not utilize a wheelchair. During the tour LPA observed 2 care staff assisting a wheelchair bound client to change their brief.

Based on LPA's interviews, investigation revealed: 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.



Exit interview conducted with Director Matilda Kodjanian and a copy of this record provided.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel BaptisteTELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5