134604232-3-14-2023-08-AS-SJAB-CQ6S2W-20230322133011

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 134604232
Report Date: 03/14/2023
Date Signed: 03/14/2023 10:21:45 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
02/04/2021 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20210204160700

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:	09:46 AM
MET WITH:	Carlolina Nunez-Garcia, Director		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Facility is charging for a resident that is no longer present at the facility

INVESTIGATION FINDINGS:

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On March 14, 2023, at about 9:46 AM, Licensing Program Analysts (LPA) Daniel Pena and Elizabeth Hamilton conducted a complaint investigation visit regarding the above-mentioned allegation. LPA was greeted at the entrance by Marisol Sanchez 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, the facility charged for a client that was no longer at the facility. The Department’s investigation consisted of virtual and onsite visits, interviews with staff and review of facility financial records. Unsuccessful attempts were made to obtain additional information from the reporting party.

Facility billing invoices were reviewed and noted that Client 1 (C1) was admitted to the facility on 10/21/2020. C1’s accommodation included medications. C1’s intake records described them as in general good health with a history of hyperthyroidism, nerve pain, substance abuse (primary alcohol),

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-20210204160700

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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and nicotine use. C1 discharged from the facility on 1/7/2021. Interviews and facility records indicate, the facility has a 10-bed guarantee with County Behavioral Health, the billed party. The arrangement was in place at the time services were provided to Client 1 (C1).

Interviews with financial staff reported that each month the 10-bed guarantee is invoiced. if more than 10 beds are utilized then additional beds are invoiced with the client’s name. Records show that the number of bed days for C1 were included in the number of days invoiced in the 10-bed guarantee. The last charges applied for C1 were for 01/06/21. C1 discharged on 01/07/21. Statements reflect that the facility bills for the day of admission but not for the day of discharge. Copies of the aforementioned invoices were obtained and confirm this information.

The Department has investigated the complaint that the facility charged for a client that was no longer at the facility. 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: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

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