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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602561
Report Date: 12/09/2022
Date Signed: 12/09/2022 04:10:11 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, 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
12/02/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20221202130909
FACILITY NAME:CARELIFE HOMESFACILITY NUMBER:
374602561
ADMINISTRATOR:CASTILLO, SEVEROFACILITY TYPE:
735
ADDRESS:9375 SIMMS COURTTELEPHONE:
(619) 303-0157
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: DATE:
12/09/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Esther Morales, CaregiverTIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has rodents and insects
Personal & Incidentals (P&I) monies are inaccurate
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced investigation visit to open a complaint investigation regarding the above mentioned allegation. LPA was greeted by, identified herself to, and explained the purpose of the visit and the basic elements of the complaint with Esther Morales, Caregiver.

During the visit, LPA toured the facility, reviewed and obtained copies of facility records. It was alleged that facility has rodents and insects. It was alleged that the facility has rodents and insects. Interviews with outside sources revealed that on November 30, 2022 a rodent ran across the kitchen floor in plain sight for others to observe. Interviews also revealed that the administrator stated the rodents must be coming into the facility through the sliding glass door off of the kitchen when the door is open. Interviews revealed that staff have put down rodent traps and sprayed for the roaches and insect bait.



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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 3
Control Number 08-AS-20221202130909
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: CARELIFE HOMES
FACILITY NUMBER: 374602561
VISIT DATE: 12/09/2022
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
It was alleged that personal & Incidentals (P&I) monies are inaccurate. Interviews revealed that on November 30, 2022 that the clients P&I monies were not accurate and did not match the documentation. Client 1 (C1) monies were off by several dollars and C2's monies were off by one hundred dollars. Interviews revealed that the money was available for the clients but it did not match what was documented. There was not exact change.
Based on the evidence obtained from interviews, records review, the complaint allegation is found to be substantiated; as the preponderance of evidence proves the alleged violation occurred.

An exit interview was conducted with Esther Morales, Caregiver 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: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20221202130909
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: CARELIFE HOMES
FACILITY NUMBER: 374602561
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2022
Section Cited
CCR
80087(a)(1)
1
2
3
4
5
6
7
Buildings and Grounds: 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.(1)The licensee shall take measures to keep the facility free of flies and other insects. This requirment is not met as evidenced by:
1
2
3
4
5
6
7
Effective immediately: The Licensee already laid traps around the facility for the rodents. Licensee will call terminix to schedule them to come out. Proof will be submitted to CCL by 12/15/2022
8
9
10
11
12
13
14
On November 30, 2022 rodents and roaches were observed in the facility. This poses a potential safety risk to clients in care.
8
9
10
11
12
13
14
Type B
12/15/2022
Section Cited
CCR
80026(h)(1)
1
2
3
4
5
6
7
Safeguards for Cash Resources, Personal Property & Valuables of Residents(h)Each licensee shall maintain accurate records,
accounts of cash resources, personal property, and valuables entrusted to his/her care, including(1)Records of clients' cash resources maintained as a drawing account, which shall include a current ledger accounting, with columns for income, disbursements &
balance, for each client. Supporting receipts for purchases shall be filed in chronological order.This requirment is not met as evidenced by:
1
2
3
4
5
6
7
Effective immediately Licensee shall ensure that the P & I money is completely documented & accurate. The administrator will balance out P&I for all clients and retrain staff on How to handle P&I. Training sign in & docs due to CCL by 12/15/2022
8
9
10
11
12
13
14
On November 30, 2022 P&I was observed to not be accurate and incomplete for 2 out of 6 clients.
This poses a potential risk to clients in care.
8
9
10
11
12
13
14
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: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3