374602092-9-26-2023-08-AS-SJAB-CW4PY3-20230928114316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602092
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:55:14 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
05/20/2022 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20220520120253

FACILITY NAME:	FRIENDLY HOME II		FACILITY NUMBER:	374602092
ADMINISTRATOR:	RONDA GAMBLE-HOLMES		FACILITY TYPE:	735
ADDRESS:	504 RITCHEY ST		TELEPHONE:	(619) 263-2127
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	22	CENSUS: 17	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:	Princess Janolino		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff did not treat client with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Caregiver Princess Janolino 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 records review and interviews with facility staff and clients.

It was reported to CCL that a staff member (S1) did not treat Client 1 (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients) with dignity and respect. It was alleged that S1 made a threatening remark to C1 since it was believed that C1 filed a complaint. Interview with Client 2 (C2) revealed C1 tends to keep to themselves since they are not well liked by the other clients. C2 further stated that C1's personality and behavior "throws off" the other clients that live in the facility. C2 stated that C2 has never witnessed or heard S1 threaten or yell at C1 or any other clients.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20220520120253

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: FRIENDLY HOME II	FACILITY NUMBER: 374602092
	VISIT DATE: 09/26/2023

NARRATIVE

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C2 further stated that S1 regularly helps C2 and the other clients with whatever they need.

Interview with C1 revealed C1 has lived at the facility for one year. C1 stated that "everyone is out to get him." When LPA asked C1 to clarify what they meant by that statement. C1 stated that C1 stopped taking a medication that "messes with your mind." C1 stated "it's mind control medication." LPA attempted to ask C1 questions about the complaint allegation but C1 became extremely distracted and agitated and LPA concluded the interview.

Administrator explained that they have asked all of the facility caregivers to attend a mandatory seminar to better understand how to treat and manage mentally disabled individuals, such as the clients that live at the facility. Regardless of whether they are high functioning or not.

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 Princess Janolino. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Princess Janolino whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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