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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601939
Report Date: 07/29/2024
Date Signed: 07/29/2024 12:06:45 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
06/24/2024 and conducted by Evaluator Rebecca A Ruiz
COMPLAINT CONTROL NUMBER: 08-AS-20240624160943
FACILITY NAME:SPECIAL FRIENDS-SAGEWOODFACILITY NUMBER:
374601939
ADMINISTRATOR:WOJCIECHOWSKI, MICHELLEFACILITY TYPE:
735
ADDRESS:13411 SAGEWOOD DRIVETELEPHONE:
(858) 312-1687
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
07/29/2024
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:House Manager Ramily HernandezTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Licensee did not maintain receipts for client monies
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to deliver findings regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit with House Manager Ramily Hernandez.

The Department's investigation consisted of interviews with clients, staff, and outside sources, records review, and a tour of the facility. It was alleged that the Licensee did not maintain receipts for client monies.

Review of client records revealed that staff log each client’s personal and incidental (P&I) monies using the Department provided LIC405 Clients/Residents Safeguarded Cash Resources Log. Review of each client’s LIC405 revealed that the documents are kept updated and staff document each withdrawal and deposit request in separate entries. Each entry includes the date of the withdrawal or deposit, description of what the monies will be used for, the amount, the total remaining balance, and signatures by both staff and clients.
Continued on LIC9099-C page.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
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 08-AS-20240624160943
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: SPECIAL FRIENDS-SAGEWOOD
FACILITY NUMBER: 374601939
VISIT DATE: 07/29/2024
NARRATIVE
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Interviews with staff and clients revealed that clients would request cash from their P&I monies and staff would give the clients the requested amount and document the transaction on that specific client’s LIC405. Review of the LIC405s did not reveal any entries that were not signed by staff and clients and a review and count of each clients’ P&I monies with the Administrator did not reveal any discrepancies.

Interviews with staff revealed that clients make a majority of their purchases while supervised by staff during outings or while at the day program, however, there are a few clients who are able to access the community independently and can make purchases independently. Interviews with staff also revealed that clients will usually keep the receipt from the store and any change left over from purchases in the client’s possession. Interviews with staff revealed that most clients are able to understand the value of money, identify prices, and determine required change independently, however, two clients require staff assistance to purchase items. Interviews with staff and LPA observations revealed that the facility has a folder for each client that contains store receipts from purchases, however, clients do not always place receipts into the folder after making purchases. Review of the folder containing client receipts revealed that two of the clients are more likely to provide staff with store receipts following purchases, but the remaining clients will keep their receipts in their possession. While the facility did not have a store receipt from each client's purchase, the facility did maintain accurate records of withdrawals and deposits of each clients’ P&I monies using individual LIC405s, with required signatures acknowledging the transaction by facility staff and clients.

The Department has investigated the above-mentioned allegation and based on interviews and records review, the preponderance of the evidence has been met, therefore, this allegation is deemed substantiated. The following deficiency is cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page.

An exit interview was conducted with House Manager Ramily Hernandez, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240624160943
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: SPECIAL FRIENDS-SAGEWOOD
FACILITY NUMBER: 374601939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2024
Section Cited
CCR
80026(h)(1)
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80026 Safeguards for Cash Resources… (h) Each licensee shall maintain accurate records of cash resources… (1) … supporting receipts for purchases shall be filed in chronological order. This requirement has not been met as evidenced by:
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House Manager stated that she has collected receipts from the 6 clients, which LPA verified visually. House Manager will conduct an inservice training with staff regarding proper P&I documentation and receipt collection.
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Based on interviews and records review, the licensee did not ensure that supporting receipts for client purchases were maintained. This poses a potential personal rights risk to 6 of 6 clients.
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 House Manager will submit the sign in sheet for the training to the Department by POC due date of 8/26/2024.
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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: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC9099 (FAS) - (06/04)
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