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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601947
Report Date: 06/16/2022
Date Signed: 06/16/2022 01:38:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/14/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220614120233
FACILITY NAME:NALAS ADULT RESIDENTIAL FACILITIES-CARLTONFACILITY NUMBER:
374601947
ADMINISTRATOR:LANGWORTHY, VERONICAFACILITY TYPE:
735
ADDRESS:2822 CARLTON WAYTELEPHONE:
(760) 451-9879
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:4CENSUS: 4DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Mikayla Weckesser, Administrative AssistantTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced to commence a complaint investigation regarding the allegations listed above. LPA met with Mikayla Weckesser, Administrative Assistant and explained the purpose of the visit, and elements of the allegation listed above. The allegations were investigated. The allegation consisted of interviews, observations and record review.

Allegation: Facility is in Disrepair
LPA conducted interviews and it was confirmed by the Administrator Christopher Warner that there is an issue with the outlet in the staff bedroom, that when you plug something in the power gets knocked out. Christopher said that he is able to fix the outlets and purchased the items to do so. Due to unforeseen health challenges He has not been able to make the necessary repairs, and any companies are not available to come out until Tuesday 6/21/22, to make the necessary repairs.. Based on observation and interviews the allegation of Facility is in disrepair *****Continued on 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
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 4
Control Number 18-AS-20220614120233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: NALAS ADULT RESIDENTIAL FACILITIES-CARLTON
FACILITY NUMBER: 374601947
VISIT DATE: 06/16/2022
NARRATIVE
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is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report , 9099D and appeal rights were provided to Mikayla Weckesser, Administrative Assistant.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20220614120233
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: NALAS ADULT RESIDENTIAL FACILITIES-CARLTON
FACILITY NUMBER: 374601947
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
06/30/2022
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by: The facility reported having 1 faulty outlet. This poses a potential, health, safety or personal rights risk to persons in care.
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The licensee agrees to replace the outlet in the live in staff bedroom. Proof is to be submitted by 5 pm on the due date indicated.
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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: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/14/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220614120233

FACILITY NAME:NALAS ADULT RESIDENTIAL FACILITIES-CARLTONFACILITY NUMBER:
374601947
ADMINISTRATOR:LANGWORTHY, VERONICAFACILITY TYPE:
735
ADDRESS:2822 CARLTON WAYTELEPHONE:
(760) 451-9879
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:4CENSUS: 4DATE:
06/16/2022
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Mikayla Weckesser, Administrative AssistantTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility common areas are not accessible to clients in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced to commence a complaint investigation regarding the allegations listed above. LPA met with Mikayla Weckesser, Administrative Assistantand explained the purpose of the visit, and elements of the allegation listed above. The investigation consisted of interviews, observations and record review.
Throughout LPAs visit, LPA did not observe any of the four clients present attempt to sit in the common area. Through interviews it was reported that the garage is considered the recreation room and that if the clients wanted to sit in the common area, they are allowed. The living does not encourage the clients to sit down, as LPA did not observe a TV, games, puzzle or books. Per the Executive Director Peyton Crow, there was a TV and a client #1 (C1) broke it, but the clients are more than welcome to sit anywhere that they please. Based on observation and interviews the allegation of Facility common areas are not accessible to clients in care is is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4