<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600947
Report Date: 03/20/2024
Date Signed: 03/20/2024 10:30:17 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
11/01/2023 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231101121922
FACILITY NAME:JIMLYS ARFFACILITY NUMBER:
374600947
ADMINISTRATOR:SHERYL ANN BARAWIDFACILITY TYPE:
735
ADDRESS:1010 METCALF STREETTELEPHONE:
(760) 781-1197
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:6CENSUS: 6DATE:
03/20/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Caregiver, Gloria BiascanTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/20/2024, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conclude the investigation into the allegation listed above. LPA was greeted and granted entry by Caregiver, Gloria Biascan, who was informed of the purpose of the visit. Licensee, Liz Barawid and Administrator, Sheryl Barawid were contacted over the phone and informed of LPA's visit.

It was reported Client 1’s (C1’s) day program staff witnessed Staff 1 (S1) hit C1 in their upper back twice and in the arm once when walking towards the door to leave for day program. LPA reviewed the facility’s file, toured the facility, conducted a record review along with client, staff, and witness interviews.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
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 3
Control Number 18-AS-20231101121922
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JIMLYS ARF
FACILITY NUMBER: 374600947
VISIT DATE: 03/20/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation, “Staff hit resident” the day program staff reported that on the morning of 11/1/2023, they arrived to the facility to transport C1 to day program and noticed S1 was adjusting C1’s leg braces. The day program staff offered to take C1’s backpack to the transportation van in the meantime and stated they walked away for approximately 1-2 minutes. The day program staff reported they did not mention they had returned to the front door to not make S1 and C1 feel rushed. The day program staff stated they observed C1 stand up, take a few steps, and accidentally step on S1’s toes. The day program staff reported they observed S1 hit C1 twice in their upper back with a closed fist and once in the arm as C1 walked towards the door to leave for day program. The day program staff believes S1 was not aware the day program staff had returned to the front door and reported there were no additional witnesses in the facility. After observing the incident, the day program staff stated they greeted C1 to indicate to S1 that they had witnessed the incident. S1 reportedly acknowledged C1 stepping on S1’s toes but did not make any comments regarding hitting C1. The day program staff reported C1 was in distress for a few hours after the incident with S1. LPA conducted a collateral visit and interviewed C1 who confirmed S1 hit C1 twice in their upper back during one (1) occasion. LPA reviewed C1’s Individual Program Plan which states, C1 has an unsteady gait and requires staff to be nearby to ensure C1 moves from one area to another without incident. LPA made several attempts to interview S1, however S1 was not responsive. Based on interviews conducted, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 1), are being cited on the attached LIC9099-D.

An exit interview was conducted and this report was read to Licensee and Administrator Barawid over the phone and a physical copy of this report was provided to Caregiver Biascan along with the LIC9099-D and Appeal Rights.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20231101121922
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JIMLYS ARF
FACILITY NUMBER: 374600947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/21/2024
Section Cited
CCR
80072(a)(3)
1
2
3
4
5
6
7
(a)(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee stated the facility conducted an in service training with all employees on 11/1/2023 regarding clients' personal rights and forms of abuse. Licensee stated they will email LPA a copy of the sign-in training sheet as proof of correction by 3/21/2024.
8
9
10
11
12
13
14
Licensee did not comply with the section noted above due to a complaint investigation revealing S1 hit C1 during one occasion. This poses an immediate safety risk to clients in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3