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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808500
Report Date: 07/18/2024
Date Signed: 07/18/2024 03:11:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/11/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240711144417
FACILITY NAME:NORTH CORDOBA MANORFACILITY NUMBER:
370808500
ADMINISTRATOR:ESPERANZA TAPIAFACILITY TYPE:
735
ADDRESS:4120 NORTH CORDOBA AVENUETELEPHONE:
(619) 670-5440
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 4DATE:
07/18/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Tony Tapia, StaffTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff physically abused client
Staff did not treat clients with respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Tony Tapia, Staff to discuss the purpose of the visit.

LPA conducted conducted a tour of the facility, interviewed clients, facility staff, and outside sources and reviewed records. It was alleged that staff physically abused client. Interviews revealed that Client 1 (C1) has been going to their day program for over 4 years. Interviews revealed C1 went to program one day and when they returned C1 told administrator that day program staff had been badgering them while at program. C1 told the administrator that the staff at program followed them around and felt as if they were being nosey and that is when C1stated they may have stated at program that the administrator hit them about 3-4 years ago. Interviews revealed that the adminsitrator called the porgram to see what was going on and they confirmed that C1 stated that.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
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 2
Control Number 08-AS-20240711144417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: NORTH CORDOBA MANOR
FACILITY NUMBER: 370808500
VISIT DATE: 07/18/2024
NARRATIVE
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Interviews revealed staff denied hitting C1 or any other clients. Interviews revealed that staff would never hit any of the clients.

It was also alleged that staff did not treat clients with respect. Interviews revealed the staff treat all clients with respect. Interviews revealed the staff work closely with the clients and assist them with their needs. There were no complaints about the staff not treating the clients with respect. Interviews revealed the staff do not yell at the clients.

The investigation did not produce supporting evidence or supporting witness statements to substantiate staff physically abused client and staff did not treat clients with respect. Based on the evidence obtained from interviews, and record review, the complaint allegations are unsubstantiated.

An exit interview was conducted with Tony Tapia, staff and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2