374600906-7-26-2023-08-AS-SJAB-CU6Q6F-20230728115326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600906
Report Date: 07/26/2023
Date Signed: 07/26/2023 10:53:37 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
07/13/2023 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20230713152902

FACILITY NAME:	WHITE, MRS. PATRICIA M.		FACILITY NUMBER:	374600906
ADMINISTRATOR:	PATRICIA M. WHITE		FACILITY TYPE:	735
ADDRESS:	12222 WINTER GARDENS DRIVE		TELEPHONE:	(619) 443-6075
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY:	3	CENSUS: 3	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Patricia White		TIME COMPLETED:	11:09 AM

ALLEGATION(S):

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Food service equipment was not kept clean

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Licensee Patricia White and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation and staff and outside agency interviews.

It was reported to CCL that food service equipment was not kept clean at the facility. It was alleged that Client 1's (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients) water botlle and straw had mold. LPA visit to the facility on July 17, 2023 revealed a supply of brand new water bottles for the clients. LPA also toured the entire facility and it was found to be; clean, orderly, with no malodor. LPA inspection of the food service equipment including dishes and cups revealed a large supply of clean, disinfected and well organized dishes and utensils.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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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Control Number 08-AS-20230713152902

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: WHITE, MRS. PATRICIA M.	FACILITY NUMBER: 374600906
	VISIT DATE: 07/26/2023

NARRATIVE

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Interview with outside agency on July 18, 2023 revealed the clients at the facility are both happy and well taken care of. Outside agency further stated that they have not encountered any issues or concerns on any of their unannounced visits to the facility.

Interview with Licensee revealed they received a call from an outside agency stating that C1's water bottle was filled with mold. Licensee stated that they advised the outside agency to throw the water bottle away since the client's have a supply of new water bottles at the facility. Licensee stated that the clients have a daily routine of filling up their water bottles before leaving to their daily program and the licensee will now make sure to both inspect and/or wash the water bottles.

Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid.

An exit interview was conducted with Patricia White. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Patricia White whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

LIC9099 (FAS) - (06/04)

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