191200236-4-11-2023-34-CR-LSMH-CR4TNH-20230421145245

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191200236
Report Date: 04/11/2023
Date Signed: 04/11/2023 04:51:35 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, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/06/2022 and conducted by Evaluator Daphne Edison

COMPLAINT CONTROL NUMBER: 34-CR-20220606091748

FACILITY NAME:	FIVE ACRES		FACILITY NUMBER:	191200236
ADMINISTRATOR:	RICE, CLAUDIA		FACILITY TYPE:	733
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY:	16	CENSUS: 16	DATE:	04/11/2023
		UNANNOUNCED	TIME BEGAN:	02:36 PM
MET WITH:	Claudia Rice-Division Director		TIME COMPLETED:	03:42 PM

ALLEGATION(S):

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Minor was physically abused while in care
Minor was pushed by staff while in care
Minor was kicked by staff while in care
Minor was physically assaulted by other minor in care
Staff member encouraged minor in care to beat up other minor in care

INVESTIGATION FINDINGS:

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On April 11, 2023, at 2:36pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations.

During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. LPA was unable to confirm the identity of Staff #1 (S1) regarding the allegations. Based on the interviews and statements obtained during the investigation process, the allegations could not be corroborated.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lakescia Smith
LICENSING EVALUATOR NAME: Daphne Edison
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

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 34-CR-20220606091748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 N. CONTINENTAL BLVD. #290B
EL SEGUNDO, CA 90245

FACILITY NAME: FIVE ACRES	FACILITY NUMBER: 191200236
	VISIT DATE: 04/11/2023

NARRATIVE

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Although it was reported that staff slapped Client #1 (C1), confidential interviews did not corroborate minor was abused while in care and minor was pushed by staff while in care. Consistent statements revealed that staff do not physically abuse minors in care. Confidential interviews did not reveal staff encouraged minor in care to beat up other minor in care. LPA was unable to corroborate the allegation minor was physically assaulted by other minor in care.
Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

SUPERVISORS NAME: Lakescia Smith
LICENSING EVALUATOR NAME: Daphne Edison
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2023

LIC9099 (FAS) - (06/04)

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