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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601574
Report Date: 08/22/2024
Date Signed: 09/18/2024 11:30:53 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2024 and conducted by Evaluator Socorro Leandro
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240821132444
FACILITY NAME:CARTAGENA HOMEFACILITY NUMBER:
198601574
ADMINISTRATOR:MARIA CHRISTINA SERAFICOFACILITY TYPE:
735
ADDRESS:1306 CARTAGENA STREETTELEPHONE:
(562) 988-8142
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:4CENSUS: 4DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Administrator - Maria Christina SeraficoTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Failure to provide adequate supervision to clients in care.
INVESTIGATION FINDINGS:
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*This is an amendment to amend deficiency and re-deliver deficiency.*

On 08/22/2024 at around 12:00 PM Licensing Program Analyst (LPA) Leandro conducted a complaint investigation regarding the allegation listed above. LPA met with Administrator, Maria Christina Serafico and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPA reviewed facility records, Client 1 (C1) and Client (C2) records. LPA interviewed C1 and 3 staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
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 3
Control Number 11-AS-20240821132444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CARTAGENA HOME
FACILITY NUMBER: 198601574
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2024
Section Cited
CCR
80078(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 not met as evidence by:
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The licensee will create a plan to ensure that tranings on care and supervision occur on a yearly basis and retrain all staff on care and supervision and email proof of correction to Socorro.Leandro@dss.ca.gov.
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Based on interviews and records review, the licensee did not provide continuous supervision to C1 and C2 on 06/29/2024.
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240821132444
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: CARTAGENA HOME
FACILITY NUMBER: 198601574
VISIT DATE: 08/22/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Failure to provide adequate supervision to clients in care” it is being alleged that on 06/29/2024 Client 1 (C1) and Client 2 (C2) were left unsupervised in a vehicle for approximately 15 minutes while Staff 1 (S1) went into a restaurant to order food. Record Review reveals the following: Harbor Regional Center Substantial Inadequacy/Immediate Danger Plan Report Corrective Action Plan (CAP) dated 08/15/2025 and Unusual Incident/Injury Report dated 07/18/2024 both indicate that C1 and C2 were left unattended in a vehicle for approximately 15 minutes by S1 on 06/29/2024 while S1 went inside a restaurant to order food. Admission Agreement for C1 and C2 both state “Services Provided…p. Continuous, in-the-house supervision, unless a written exception is granted by Regional Center and licensing agency (Title 22, 80024).” Regional Center Individual Person-Centered Plan for C1 and C2 both state they are “provided with 24 hour care and supervision by home staff.” Interviews conducted reveal the following: C1 confirmed that the allegation occurred. Staff 2 and Staff 3 both indicated that C1 informed them that C1 and C2 were left alone in a vehicle on 06/2024. Regarding the allegation “Failure to provide adequate supervision to clients in care,” the preponderance of the evidence standard has been met therefore the allegation is substantiated.

Deficiencies cited based on LPA records review and interviews conducted in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted, and a copy of this report was left with the Administrator along with their appeal rights.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3