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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600276
Report Date: 09/22/2023
Date Signed: 09/22/2023 04:05:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/31/2021 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20210831162033
FACILITY NAME:CASA DE CASTROFACILITY NUMBER:
374600276
ADMINISTRATOR:CHERYL M. CASTROFACILITY TYPE:
740
ADDRESS:5581 CHATTANOOGATELEPHONE:
(619) 267-3934
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: 6DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Caregiver, Edna FranciaTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Staff not treating resident with dignity
INVESTIGATION FINDINGS:
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Licensing Program Manager (LPM) Lizzette Tellez conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPM was met by Caregiver, Edna Francia, and was allowed entry into the facility. LPM spoke with Licensee/Administrator, Cheryl Castro, by phone to discuss the purpose of the visit.

Investigation consisted of interviews with residents, staff, outside sources, and a tour of the facility. It was alleged that staff did not treat Resident #1 (R1) with dignity, specifically that Staff #1 (S1) provided showers to R1 in the backyard area. Interviews with staff and outside sources revealed that staff provided showers to R1 on the back porch, with the use of a shower chair. Interviews with S1 revealed that staff occasionally do this due to fear of R1 falling, and due to needing help to get R1 into the tub. Interview with R1 yielded contradictory statements. During a tour of the facility, a shower chair and sheet were observed on the back porch. The Department has investigated the allegation that staff did not treat R1 with dignity. Based upon the evidence found during the investigation, including interviews and LPA observation, the preponderance of the evidence standard has been met. Therefore, the allegation is deemed substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
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 5
Control Number 08-AS-20210831162033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CASA DE CASTRO
FACILITY NUMBER: 374600276
VISIT DATE: 09/22/2023
NARRATIVE
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This deficiency is noted on the attached LIC 9099-D and is cited in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with Ms. Castro and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to them at the conclusion of the visit.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20210831162033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CASA DE CASTRO
FACILITY NUMBER: 374600276
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2023
Section Cited
CCR
87468.1(a)(1)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES
(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.
This requirement was not met as evidenced by:
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Licensee Cheryl Castro provided that a personal rights refresher training to alll staff. S1 is no longer employed at the facility. POC due to CCL by POC due date 9/29/23.
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Based on interview and LPA observation, the licensee did not ensure staff accorded R1 with dignity. This posed a potential personal rights risk to one of six residents in care.
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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.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/31/2021 and conducted by Evaluator Lizzette Tellez
COMPLAINT CONTROL NUMBER: 08-AS-20210831162033

FACILITY NAME:CASA DE CASTROFACILITY NUMBER:
374600276
ADMINISTRATOR:CHERYL M. CASTROFACILITY TYPE:
740
ADDRESS:5581 CHATTANOOGATELEPHONE:
(619) 267-3934
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: DATE:
09/22/2023
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:TIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility bathroom is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Manager (LPM) Lizzette Tellez conducted an unannounced complaint visit to deliver findings on the above-mentioned allegation. LPM was met by Caregiver, Edna Francia, and was allowed entry into the facility. LPA met with Ms. Francia and discussed the purpose of the visit. LPM spoke with Licensee/Administrator, Cheryl Castro, by phone to discuss the purpose of the visit.

Investigation consisted of interviews with residents, staff, outside sources, and a tour of the facility. It was alleged that a facility bathroom was in disrepair. The bathroom in question is the bathroom located in a shared bedroom. Interviews with residents did not support the allegation, as residents interviewed were unable to recall if the bathroom was in working condition. During a tour of the facility, LPA observed both facility bathrooms to be working, including the showerheads and sinks. No leakage or spills were observed. The closet in the shared bedroom was observed to have some damage on the floor. LPA observed that the floor of the closet adjacent to the bathroom appeared to have a depression or indentation. Licensee/Administrator, Cheryl Castro, provided that there had been a leak in the bathroom, but a plumber was called, and it was fixed approximately one month prior to the initial visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20210831162033
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CASA DE CASTRO
FACILITY NUMBER: 374600276
VISIT DATE: 09/22/2023
NARRATIVE
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The Department has investigated the allegation that the facility bathroom was in disrepair and has found that there is insufficient evidence to corroborate the allegation. Therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Ms. Castro and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to them at the conclusion of the visit.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5