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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004674
Report Date: 04/23/2025
Date Signed: 04/23/2025 08:37:16 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2025 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250220085114
FACILITY NAME:CATHERINE'S RESIDENTIAL CARE HOMEFACILITY NUMBER:
306004674
ADMINISTRATOR:MICHAEL SAN DIEGOFACILITY TYPE:
735
ADDRESS:700 W. ELM AVENUETELEPHONE:
(714) 525-8917
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:5CENSUS: 5DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Joan BaltazarTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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Staff hit client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff and clients as well as reviewed and obtained pertinent documentation such as facility notes. Regarding the allegation that staff hit client, the investigation revealed the following: On 02/17/2025, Client 1 (C1) was taken to the emergency room after severe behaviors the night before when the client was engaging in self injurious behaviors. Facility documentation indicates that in the evening of 02/16/2025, the client started having a tantrum and was hitting the client's head on the wall. At the emergency room, staff had difficulty redirecting the client from the vending machine causing agitation on the client's part. Once redirected away from vending machine, C1 told the physician that a staff had hit her 20 times. Staff explained the client's behaviors and history of false statements to the physician. The client was seen for perforation of left tympanic membrane, ear pain and headache. Five out of five staff deny any hitting of the client occurring. CONTINUED ON LIC 9099C DATED 04/23/2025
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 2
Control Number 22-AS-20250220085114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CATHERINE'S RESIDENTIAL CARE HOME
FACILITY NUMBER: 306004674
VISIT DATE: 04/23/2025
NARRATIVE
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C1 confirms allegation of hitting to LPA. Two out of two clients interviewed state liking it at the facility and no hitting or yelling occurring. Per Individual Program Plan dated 08/28/2024, C1 has a history of physical aggression, self injurious behavior, misrepresentation of facts, accusing others and property damage. C1 is diagnosed with Autism and Psychiatric Disorder. Based on interviews conducted and record review, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2