374602092-8-30-2022-08-AS-JRAE-CHTUWD-20220831155633

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602092
Report Date: 08/30/2022
Date Signed: 08/30/2022 12:27:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/08/2022 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20220808154538

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:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Luz Santos		TIME COMPLETED:	12:39 PM

ALLEGATION(S):

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Facility television is in disrepair.

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 Luz Santos 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 LPA direct observation, records review, interviews with facility staff and clients.

On August 16, 2022 LPA conducted a facility visit which included observation of the television in the dining hall. Interview with client revealed no knowledge of any "broken" television. Interview with Caregiver revealed that although the television is in working condition it did not currently work properly since the remote control was recently re-programmed by the clients. Interview with Administrator revealed that in March and April 2021 repairmen from Cox Cable visited the facility to fix the television. The Administrator further stated that the clients refuse to follow staff directives and continually press multiple buttons on the remote control

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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-20220808154538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: FRIENDLY HOME II	FACILITY NUMBER: 374602092
	VISIT DATE: 08/30/2022

NARRATIVE

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which in turn re-programs the television, resulting in the television no longer working. The Administrator stated that he pays a fee each time the repairmen go out to the facility.

On August 26, 2022 Administrator provided a photograph of the television in working condition.

Based on LPA observations, interviews, and outside sources we have found that the preponderance of the evidence standard has not been met therefore, the allegation is found to be unsubstantiated.

An exit interview was conducted with Luz Santos and a copy of this report and Licensee/Appeal Rights (LIC 9058 3/22) were provided to Luz Santos whose signature below confirms receipt of documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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