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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191600093
Report Date: 12/05/2024
Date Signed: 12/05/2024 01:32:26 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240725103347
FACILITY NAME:BAY BREEZE CAREFACILITY NUMBER:
191600093
ADMINISTRATOR:DIMATULAC, RODOLFOFACILITY TYPE:
735
ADDRESS:1653- 55 SANTA FE AVETELEPHONE:
(562) 432-8033
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:76CENSUS: 61DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Jemimah MejiaTIME COMPLETED:
11:59 AM
ALLEGATION(S):
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Facility clients are using illegal drugs inside the facility.
INVESTIGATION FINDINGS:
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On 12/05/24, the Department conducted a subsequent unannounced complaint visit at this facility. The Community Care Licensing (CCL) associate was greeted by the administrator (S1:Jemimah Mejia). The CCL associate explained that the purpose of this visit was to deliver findings for the allegation mentioned above.

The investigation consisted of the following: A health and safety inspection on 07/26/24. An investigation by a CDSS/CCL associate between 08/21/24 and 08/24. A review of Facility Roster (dated 07/26/24), Personnel Report LIC 500 (dated 07/1/24 through 08/24/24), (C1's, C2's, and C4's) Individual Service Plan (dated 11/09/22, 11/18/22, 01/10/23, and 02/02/24), Psychiatric Medical Report (dated 05/15/24) and Preplacement Appraisal Information LIC 603 (dated: 11/22/22), Long Beach Police Department various reports (dated 05/05/24, 05/14/24, 05/21/24, 06/29/24, and 09/03/24), and CDSS Investigation Branch Report (dated 11/21/24).
(Evaluation Report continues LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 4
Control Number 11-AS-20240725103347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BAY BREEZE CARE
FACILITY NUMBER: 191600093
VISIT DATE: 12/05/2024
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Facility clients are using illegal drugs inside the facility.

The nature of this complaint alleges that clients are using illegal drugs in the facility. Information provided reported that clients were smoking illegally and participating in drug activities inside the facility.

On 08/21/24 and 10/08/24 between 12:30 pm – 01:30 pm, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (2) out of (4) clients captured on video surveillance admitted to smoking Methamphetamine while at the facility. Client #2-#3 (C2-C3) admitted to participating in illegal drug activity while at the facility, and that facility staff was unaware that they were abusing narcotics on the premises. (C1) declined to provide names of clients and denied that (C1) abuses narcotics in the facility. (C4) was absent at the facility and could not be reached for comments or statements.

On 09/30/24, between 12:00 pm – 01:15 pm, the California Department of Social Services/Community Care Licensing (CDSS/CCL) associate interviewed (2) out of (2) staff and claimed they had not observed any clients abusing narcotics. (S1-S2) stated they conducted room searches, which included (C1-C4) rooms, and found no narcotics. The facility staff enforces house rules to stop clients from abusing drugs in the facility, according to (S1). (S1) is implementing a “house rules” checklist that will have all clients review and sign. The rules will include room inspection and zero tolerance of drug abuse on the facility grounds. (S1) stated that (C1) is a former client who moved out of the facility on 09/19/24. (S1) added that shortly before (C1) moved out, “(C1) OD’d” and was found on the floor by staff in (C1’s) room and was taken by Emergency Medical Technician (EMT), which resulted in a brief hospitalization. (S1) reported that the facility staff did not include caregivers.

On 12/04/24, between 11:28 am – 11:38 am, the California Department Social Services/Community Care Licensing (CDSS/CCL) associate interviewed former administrator staff #3 (S3). (S3) repeated the same statements, stating that staff conducted room searches and enforced house rules. (S3) reported that the facility staff included med-techs, housekeepers, janitors, assistant administrators, activities directors, and facility coordinator. (S3) expressed that during (S3’s) tenure at Bay Breeze Care, Inc., there were no caregivers, nor were existing staff cross-trained. Due to the housekeeping staff's direct access to client rooms, (S3) required them to report inappropriate client activities to the administration.

(Evaluation Report continues LIC-9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240725103347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: BAY BREEZE CARE
FACILITY NUMBER: 191600093
VISIT DATE: 12/05/2024
NARRATIVE
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As a result of the Department reviewing (C1's, C2's, and C4's) Individual Service Plan (dated 11/09/22, 11/18/22, 01/10/23, and 02/02/24), Psychiatric Medical Report (dated 05/15/24) and Preplacement Appraisal Information LIC 603 (dated: 11/22/22) revealed a history of substance abuse and required continuous supervision. The Long Beach Police Department reported that (C1) exhibited detrimental behavior related to substance abuse in various reports (dated 05/05/24, 05/14/24, 05/21/24, 06/29/24, and 09/03/24). Personnel Report LIC 500 (dated 07/1/24 through 08/24/24) indicated no caregivers scheduled.

Based on evidence gathered, interviews conducted, records reviewed, and video footage, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF CARE AND SUPERVISION: Facility clients are using illegal drugs inside the facility is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation issued (ref. LIC 9099D).

An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights were provided to the Administrator (Jemimah Mejia).

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240725103347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BAY BREEZE CARE
FACILITY NUMBER: 191600093
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2024
Section Cited
CCR
80087(a)
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80078-Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
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Licensee will update procedures on how all house rules will be enforced, the procedures shall include but not limited to; fair enforcement practices, documentation of infractions; administrator will provide a plan of action to impede the use of client illegal drug use in facility. POC is due to CCL by 12/06/24.
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During the course of this investigation, CDSS/CCL discovered that illegal drugs such as Methamphetamine were consumed by(C2-C3) along with video footage as evidence. There is no caregiver on staff to provide care and supervision to clients. This violation poses an immediate health, safety, or personal rights risk to persons in care.
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(Examples: Documentation in client files, Counseling, Updating client Needs/Services Plan, In-service training, Issuing eviction notices for breaking house rules, Hourly check-ups by staff).
Type A
12/06/2024
Section Cited
CCR
80064(a)(3)
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80064-Administrator - Qualifications and Duties. The administrator shall have the following qualifications: Knowledge of and ability to comply with applicable law and regulation. Administrator failed to comply with Title 22 Regulation Sections 80078(a) and 80061(b).This requirement is not met as evidenced by:
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Licensee will submit a detailed plan on how the facility will monitor and check clients to ensure that clients are receiving the necessary care and supervision. The plan must also include the preventative measures on the use of illegal drugs. POC is due to CCL by 12/06/24.
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During this investigation, CDSS/CCL discovered that the facility did not have caregivers on staff to supervise clients' needs. This violation poses an immediate risk to persons in care's health, safety, or personal rights..
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(Examples: Documentation that staff will be cross-trained as caregivers or/hire caregiver staff to meet client's needs).
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4