198601522-4-18-2022-28-AS-MVAO-CDNLWH-20220420090709

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601522
Report Date: 04/18/2022
Date Signed: 04/18/2022 12:37:41 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, 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
12/09/2021 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20211209101516

FACILITY NAME:	LYDAY HOME		FACILITY NUMBER:	198601522
ADMINISTRATOR:	OLAIDE OSIBOGUN		FACILITY TYPE:	735
ADDRESS:	559 E. CYPRESS STREET		TELEPHONE:	(626) 498-0620
CITY:	COVINA	STATE: CA	ZIP CODE:	91723
CAPACITY:	4	CENSUS: 4	DATE:	04/18/2022
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Olaide Osibogun - Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff member caused resident injury.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with administrator Olaide Osibogun and explained the reason for the visit.

The investigation consisted of the following: On 12/9/21 LPAs Flores and Baptiste conducted a health and safety check of the facility and observed the following: Four (4) clients in the facility and seem well. Kitchen was observed with sufficient food supplies of at least 2 days of perishables and 7 days of non-perishables. Sharps and medication are locked in a cabinet in the dinning room. 3 Bedrooms and 2 bathrooms were observed with all furniture and bedding supplies. Water temperature was tested in clients bathroom between 110.4- 110.5 degrees F, which is within Title 22 regulations. Cleaning supplies were observed locked. Smoke detectors were tested and in working condition. LPAs collected resident roster, staff roster, face sheets for 4 clients, and incident reports for the last month. On 12/9/21 Investigation Bureau returned complaint for Regional Office to conduct investigation. On 12/13/21 LPA Flores interview San Gabriel Pomona Regional Center Service Coordinator (SGPRC). On 4/7/22 LPA Flores contacted SGPRC Service Coordinator and request Quality Assurance Letter of Findings. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

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-20211209101516

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: LYDAY HOME	FACILITY NUMBER: 198601522
	VISIT DATE: 04/18/2022

NARRATIVE

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On 4/15/22 LPA Flores submitted a request to Covina Police Deparment Records Division for any Police Report on record and attempt to interview C1's family representative. On 4/18/22 LPA Flores conducted interviews with client #1(C1),#2(C2),#3(C3), administrator, staff #1(S1), interviewed staff#2(S2), and #3(S3) over the phone, and attempted to interview client #4(C4).

The investigation revealed the following: Regarding allegation: Staff member caused resident injury. It is alleged Adult Day Program staff noted a laceration the size of a dime observed on top of C1's head. C1 reported that a staff member in C1's room with green eyes had caused the injury. On 12/9/21 LPAs observed a scab of about 1/2 an inch in length and 1 centimeter in width on top of C1's head. Scab was observed to be dried and superficial, no other scars or bruises were observed. On 12/13/21 SGPRC Service Coordinator stated C1 communicated to Quality Assurance Specialist to have "self afflicted the wound after a haircut and being exposed to the sun". Interview conducted on 4/18/22 with Day Program Director revealed that initially C1 had claimed a staff had inflected the injury, however "C1 after stated to had inflected the injury self". Interviews with clients revealed the following, C1 stated to sometimes feel itchy and scratches head after haircut, and usually happens after a haircut. LPA was unable to interview C2, and C3 due to cognitive skills and C4 was out at day program. Interviews with staff revealed 3 out of 3 staff stated to not have observed staff mistreat or hit clients and have not had heard clients state to have been hurt or mistreat by staff. Administrator stated C1 has a history of false allegations, non of the staff have green eyes, C1 has eczema and tends to get itchy specially after a haircut, C1 had a haircut around the time of the wound. Administrator submitted incident report for scab in C1's head to the department on 12/9/21, and Covina Police Department officers came out interview clients, however no report or contact information was provided. LPA reviewed C1's documents Incident Report was submitted to the department on 12/9/21 for self injury behavior. Medical/Specialist Visit Information dated 12/20/21 followed up on rash on head, treatment was provided. Individual Program Plan (IPP) dated 1/6/20 notes C1's team will continue to work on inappropriate behaviors which include aggressive and false statement behaviors. LPA reviewed SGPRC finding letter dated 12/10/21 in which regional center conducted an investigation regarding the allegation and provided an Unsubstantiated finding. No police report was reviewed.

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 was conducted with Olaide Osibogun Administrator and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022

LIC9099 (FAS) - (06/04)

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