342700887-3-3-2022-27-AS-KHOS-CCDJ5M-20220310054454

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700887
Report Date: 03/03/2022
Date Signed: 03/03/2022 04:24:45 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2022 and conducted by Evaluator Anthony Tuck

COMPLAINT CONTROL NUMBER: 27-AS-20220209154703

FACILITY NAME:	EMMA & JOYCE DIALA UNIQUE HOME		FACILITY NUMBER:	342700887
ADMINISTRATOR:	DIALA, MANUEL		FACILITY TYPE:	735
ADDRESS:	7354 ALDEN WAY		TELEPHONE:	(916) 821-4214
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95828
CAPACITY:	4	CENSUS: 1	DATE:	03/03/2022
		UNANNOUNCED	TIME BEGAN:	03:08 PM
MET WITH:	Administrator Manuel Diala		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Resident wandered away from the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anthony Tuck arrived announced at the facility on 03/03/2022. LPA was met by Administrator Manuel Diala. LPA explained the reason for the visit to deliver findings regarding the complaint investigation for the allegation listed above.

LPA conducted an initial investigation at the facility on 02/15/2022. LPA interviewed the administrator and requested copy of IPP, behavioral report, and copies of SIR’s for R1 regarding all behaviors and incidents for R1. LPA requested copy of LIC 602 for R1 due to AWOL occurrence. LPA performed a Case Management visit on same day as initial investigation of the complaint. LPA learned from review of the LIC 602 for R1 that although R1 has a diagnosis of unspecified mood disorder, R1 is allowed to leave the facility unassisted. LPA reviewed copies of past SIR’s reported by the Administrator regarding R1’s behaviors. LPA observed that R1 has a history of calling 911, punching walls, acting out, and having behavioral problems as a result of loosing at video games on his gaming console.
Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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 27-AS-20220209154703

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: EMMA & JOYCE DIALA UNIQUE HOME	FACILITY NUMBER: 342700887
	VISIT DATE: 03/03/2022

NARRATIVE

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LPA reviewed the action plan for R1 and learned that treatment was provided by psychiatrist, and behaviorist at Turning Point as part of an ongoing treatment plan for R1 and his behaviors. LPA learned that the administrator followed all plans of action to provide counseling and seek treatment plans for R1.
Based upon review of documentation received and interviews conducted, there is not substantial evidence to support or disprove that the alleged violation occurred. Due to the preponderance of evidence standard not being met by the department standard. There is no physical evidence to support the validity of the allegation; LPA has deemed the complaint findings as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with administrator Manuel Diala, a copy of the report was provided to administrator upon exit.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Anthony Tuck
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

LIC9099 (FAS) - (06/04)

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