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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134600626
Report Date: 05/22/2024
Date Signed: 05/22/2024 10:43:17 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
05/08/2024 and conducted by Evaluator Amy Rodgers
COMPLAINT CONTROL NUMBER: 08-AS-20240508231327
FACILITY NAME:SMOKETREEFACILITY NUMBER:
134600626
ADMINISTRATOR:ELIZABETH WAYCOTTFACILITY TYPE:
735
ADDRESS:1663 SMOKETREE DRIVETELEPHONE:
(760) 353-6203
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:6CENSUS: 0DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Direct Care staff, Jason ArmstrongTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Physical abuse to client by staff member resulting in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Amy Rodgers, conducted an unannounced visit of a complaint investigationt, and delivered complaint findings. The LPA introduced herself and disclosed the purpose of the visit to Direct Care staff, Jason Armstrong.

Throughout the investigation, the Department secured records and conducted interviews with external and internal sources.

It was alleged staff physically abused a client that resulted in an injury to nose and below chin. On 05/8/2024, the Department received an SOC 341 of suspected adult abuse. It was reported Client # 1 (C1) had sustained an injury due to staff abuse. According to C1’s (Individual Servce Plan) ISP report and addtional records, C1 has a history of fabrication. Interview with C1 did not confirm S1 injured C1.

(See LIC 9099C form for continuation of report.)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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 2
Control Number 08-AS-20240508231327
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SMOKETREE
FACILITY NUMBER: 134600626
VISIT DATE: 05/22/2024
NARRATIVE
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Interview without Outside Source 1 (OS1) as well as photographic evidence revealed that there was a visible injury on C1 however, the interview by OS1 to C1 was conducted using leading questions. Interview with OS2 confirmed C1's has a history fabrication.

Interview with staff confirmed they were not aware of an injury to C1 and daily house logs confirmed body checks.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Direct Care Staff Jason Armstrong to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2