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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600546
Report Date: 06/13/2024
Date Signed: 06/14/2024 06:48:22 AM

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
05/29/2024 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20240529134036
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: 9DATE:
06/13/2024
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Caregiver Julita RenojoTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not ensure a safe environment is provided for residents.
Staff did not meet reporting requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver investigative findings on the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit to Caregiver Renojo.

The Department’s investigation consisted of client, staff, outside source interviews, and a facility records review.

It was alleged facility staff do not ensure a safe environment. Interviews conducted with Staff 1 (S1) and Staff 2 (S2) revealed on May 28, 2024, Client 1 (C1) and Client 2 (C2) were involved in a physical altercation. S1 revealed hearing a chair fall over outside in the backyard area and observed C1 and C2 fighting. S1 intervened to stop the altercation and instructed Staff 3 (S3) to activate 911. S1 also revealed both C1 and C2 had abrasions to their heads however both clients refused medical treatment once the paramedics arrived. Interviews conducted with other Clients in care corroborated S1's statement and revealed feeling the facility is a safe environment. An interview conducted with Outside Source 1 (OS1) also corroborated that 911 was activated and C1 refused medical treatment. [See LIC 811 to identify Confidential Names]

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
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-20240529134036
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: 06/13/2024
NARRATIVE
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It was also alleged facility staff did not meet reporting requirements. A facility records review revealed CCL received notification within the time frame per Title 22 reporting requirement mandate.

Based on interviews conducted with facility staff, an outside source, and clients in care, and a facility records review the above mentioned allegations were determined to be unsubstantiated. This finding means although the allegations may have happened or could be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA conducted an exit interview with Caregiver Renojo. At the time of the exit interview LPA notified Caregiver Renojo a copy of this Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided at the conclusion of the visit and signature on this report acknowledges receipt of the documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2