134604232-3-14-2023-08-AS-SJAB-CQ6SML-20230322140006

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 134604232
Report Date: 03/14/2023
Date Signed: 03/14/2023 10:20:51 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
03/29/2021 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20210329161844

FACILITY NAME:	JACKSON HOUSE EL CENTRO		FACILITY NUMBER:	134604232
ADMINISTRATOR:	CAROLINA NUNEZ-GARCIA		FACILITY TYPE:	772
ADDRESS:	2364 SOUTH 2ND STREET		TELEPHONE:	(760) 237-9769
CITY:	EL CENTRO	STATE: CA	ZIP CODE:	92243
CAPACITY:	16	CENSUS: 7	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Carolina Nunez-Garcia, Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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-Facility failed to protect client from harm
-Staff not able to communicate effectively with client

INVESTIGATION FINDINGS:

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On March 14, 2023, at about 9:15 AM, Licensing Program Analysts (LPA) Daniel Pena and Elizabeth Hamilton conducted a complaint investigation visit regarding the above-mentioned allegations. LPAs were greeted at the entrance by, Marisol Sanchez, Office Manager and granted entry after identifying themselves and disclosing the reason for the visit. LPA was met by Executive Director, Carolina Nunez-Garcia, to whom LPA discussed the findings of the investigation.

It was alleged, facility staff did not protect a client from harm and did not effectively communicate in English with clients. The Department’s investigation consisted of virtual and onsite visits, record reviews and interviews with clients and staff.

Outside records indicate on 3/28/2021, at about 10:15 PM, Client 1 (C1) physically battered Client 2 (C2) while both were clients at the Jackson House, Social Rehabilitative facility. A law enforcement officer responded and investigated the incident. Facility staff also self-reported the incident to CCLD.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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 08-AS-20210329161844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: JACKSON HOUSE EL CENTRO	FACILITY NUMBER: 134604232
	VISIT DATE: 03/14/2023

NARRATIVE

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According to outside agency reports, C2 was in the dining room studying their bible when C1 approached C2 trying to apologize for something. C2 told C1 that they wanted to be left alone. C1 then punched C2 on the head which caused C2 to fall off of their chair. C2 personally requested medical attention via 911 and was transported to a local hospital for treatment. The outside source did not see blood or obvious injury to C2.

Record reviews and interviews indicate that C2 and Staff 1 (S1) were sitting in the dining room when C1 approached C2. C1 told outside sources that C1 and C2 had a tense interaction with each other earlier in the day. According to C1’s statement, C1 wanted to apologize to C2. C2 did not acknowledge C1's apology so C1 swung at C2 but did not make contact. When C1 swung, C1 said C2’s reaction was fake because they fell to the ground as if they were hit. C1 told outside sources that C1 was bipolar and taking medication. Interviews indicated S1 was present during the incident between the two clients. S1 saw C2 swing at C1 and separated the two clients.

Record reviews and interviews did not provide statements or other evidence suggesting staff failed to protect C2. Based on records and interviews, staff acknowledged the tension between the two clients and attempted to limit their exposure to each other. Staff was present at the time C1 spontaneously swung at C2 and assisted in separating the clients.

It was also alleged Staff 2 did not communicate effectively in English with clients. Attempts were made to obtain details regarding this allegation, but none were available. LPA interviewed S2 and observed them to speak effectively in English.

The Department has investigated the complaint that facility staff did not protect a client from harm and did not effectively communicate in English with clients. Based upon the information gathered during this investigation; it is determined that although the incident may have happened and is valid, there is not a preponderance of evidence to prove it occurred and is therefore UNSUBSTANTIATED.

An exit interview was conducted, and the report was reviewed with Director, Nunez-Garcia. A copy of the report and Licensee Appeal Rights was provided to Director Nunez-Garcia and her signature on this report confirms receipt of receiving the document.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023

LIC9099 (FAS) - (06/04)

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