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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134601177
Report Date: 02/27/2024
Date Signed: 02/27/2024 01:22:08 PM

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
04/28/2023 and conducted by Evaluator Tiffany Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230428093340
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA EL CENTROFACILITY NUMBER:
134601177
ADMINISTRATOR:ZAVALA, REYNAFACILITY TYPE:
775
ADDRESS:453 MAIN STTELEPHONE:
(760) 482-2777
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:80CENSUS: 80DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
01:08 PM
MET WITH:Genevieve Garcia, Supervisor ADSTIME COMPLETED:
01:26 PM
ALLEGATION(S):
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Client sustained unexplained injury while in care.
Licensee failed to report incident involving client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Tiffany Holmes, conducted an unannounced visit to close a complaint investigation regarding the above mentioned allegations. The LPA was greeted by Genevieve Garcia, Supervisor ADS. The LPA indentified herself, was granted entry to the facility, and disclosed the purpose of the visit.
During the investigation, the LPA conducted a tour of the facility, conducted interviews, and reviewed pertinent records. It was alleged that the client sustained unexplained injury while in care. Interviews revealed the cliet was having a behavior on April 27, 2023 and fell to the ground. Records review also showed the client having a seizure on April 28,2023 where they fell to the ground. Interviews revealed the staff at the facility did not see any bruises on C1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
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-20230428093340
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: EASTER SEALS SOUTHERN CALIFORNIA EL CENTRO
FACILITY NUMBER: 134601177
VISIT DATE: 02/27/2024
NARRATIVE
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Interviews revealed the staff at C1s facility reported to the day program that they saw a bruise when C1 got home from program and reported it to the program the next day. Interviews revealed the client has a behavior where they throw them selves down to the ground and start yelling. Interviews revealed the staff attempted to assist C1 with getting up off the floor and interviews revealed they would never intentionally harm a client. The investigation did not produce supporting evidence to prove the client sustained unexplained injury while in care.

It was alleged that the licensee failed to report incident involving client. Interviews revealed there was nothing to report because they did not know of the bruise until the facility staff at the home mentioned it to them the next day. Interviews revealed
that once they were made aware of the bruise they reported it immediately. Interviews revealed any incident that has occurred at the facility they have always reported all incidents. The investigation did not produce supporting evidence to prove the licensee failed to report incident involving client.

Based on LPAs observations of the records review and interviews the above allegations are unsubstantiated.

An exit interview was conducted with Genevieve Garcia, Supervisor ADS, to whom a copy of this report and Licensee's Rights (LIC 9058 03/22) were provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2