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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601175
Report Date: 01/25/2024
Date Signed: 01/25/2024 02:45:01 PM

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
12/06/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20211206113012
FACILITY NAME:DSC, INC. - BUENA VALLEY HOUSEFACILITY NUMBER:
374601175
ADMINISTRATOR:DIANE SPURGEONFACILITY TYPE:
735
ADDRESS:1787 DUPONT DRIVETELEPHONE:
(619) 460-7333
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:3CENSUS: 3DATE:
01/25/2024
UNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Gabriela Garcia, StaffTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not supervise client resulting in injury.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Gabriela Garcia, Staff to discuss the purpose of the visit.
LPA conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that facility did not supervise client resulting in injury. Interviews revealed that on December. 4, 2021, Client 1 (C1) sustained an injury while at the facility. Interviews revealed that around 1:30 am C1 was observed to be asleep by the staff on duty doing their rounds. Interviews revealed that around 2am, staff was doing another round and observed the clientsquatting on the floor next to their bed. According to staff interviews, the client did not make any loud noises and when they tried to assist the client the client did not oblige.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
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-20211206113012
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: DSC, INC. - BUENA VALLEY HOUSE
FACILITY NUMBER: 374601175
VISIT DATE: 01/25/2024
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
 Interviews revealed soon thereafter the staff took off C1 sock to observe their body and that is when they observed a bulge on the clients ankle. Interviews revealed the staff called 911 and the on call staff and they arrived around the same time and the ambulance took C1 to the hospital and the on call staff went with the client. There is no witness statements that confirm the facility did not the supervise client resulting in injury.

Based on the evidence obtained from interviews, and records review, the complaint allegation is unsubstantiated. An exit interview was conducted with Gabriela Garcia, Staff and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2