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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600546
Report Date: 08/10/2023
Date Signed: 08/10/2023 04:16:11 PM

Substantiated


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
07/21/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230721110332
FACILITY NAME:CAL-CRIS LODGEFACILITY NUMBER:
374600546
ADMINISTRATOR:GLADYS BELTRANFACILITY TYPE:
735
ADDRESS:8944 EMERALD GROVE AVENUETELEPHONE:
(619) 390-8501
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY:10CENSUS: 7DATE:
08/10/2023
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Caregiver, Julita RenogoTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff spoke inappropriately to client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to deliver findings on the above allegation. LPA was granted entry by Caregiver, Julita Renogo. During this visit, Licensee, Jun Beltran joined the meeting via conference call, and LPA proceeded to deliver findings.

The Department investigated the above-listed complaint allegation. The investigation consisted of interviews with facility staff and clients.

On July 21, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff (S1) spoke inappropriately to a client (C1), [an LIC 811 Confidential Names List was provided to staff to identify the client and staff].

(Continue on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
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 3
Control Number 08-AS-20230721110332
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: CAL-CRIS LODGE
FACILITY NUMBER: 374600546
VISIT DATE: 08/10/2023
NARRATIVE
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(Continue from LIC9099)


It was specifically alleged that S1 made loud inappropriate statements to C1 which were determined to violate C1’s personal rights of being accorded dignity. The specific date when this incident occurred was not obtained during the investigation; however, multiple interviews with facility staff and outside sources who witnessed the incident confirmed that S1 made loud inappropriate statements directed at C1. S1 admitted the allegation and expressed regret for their actions.

We have found there is a preponderance of evidence to prove the alleged violation occurred and is therefore substantiated. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D, and a plan of correction was jointly developed with the Licensee, Jun Beltran.

An exit interview was conducted with Licensee, Jun Beltran who joined in via conference call; a copy of this report, Deficiency LIC9099D, LIC811, and Licensee's Rights (LIC9058) were provided to Caregiver, Renogo.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230721110332
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: CAL-CRIS LODGE
FACILITY NUMBER: 374600546
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/08/2023
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights.
Personal Rights. To be accorded dignity in his/her personal relationships with staff and other persons.

This requirement was not met as evidenced by:
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Licensee agreed to conduct additional training on personal rights with all staff, including S1. Licensee will submit sign-in sheets and training materials as verification by POC date of September 8, 2023.
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Interviews revealed that staff S1 spoke inappropriately to client C1. This posed a potential personal rights risk to 1 of 9 clients 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.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 08/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3