372004630-12-1-2022-18-AS-DMUN-CNLW5R-20230131155934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 372004630
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:01:55 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/22/2022 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221122132324

FACILITY NAME:	COUNTRY CLUB GUEST HOME		FACILITY NUMBER:	372004630
ADMINISTRATOR:	RAMIREZ, JULIE		FACILITY TYPE:	740
ADDRESS:	25533 RUA MICHELLE		TELEPHONE:	(760) 747-0957
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY:	30	CENSUS: 27	DATE:	12/01/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Juanario Payumo, Caregiver		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Violation of Personal Rights

INVESTIGATION FINDINGS:

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Licesning Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initate an investigation into the allegation listed above. LPA met with Caregiver Juanario Payumo and explained the purpose of the visit.
LPA spoke with Licensee/Administrator Julie Ramirez via telephone regarding Resident #1(R1). Ramirez reported R1 no longer resides at the facility. Ramirez reported R1 moved out of the facility in October 2022 and believed R1 now resides at a facility located in Lemon Grove.
This agency has investigated the complaint alleging "Violation of Personal Rights". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 12/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022

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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