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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602610
Report Date: 01/19/2024
Date Signed: 01/19/2024 02:19:03 PM

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
01/12/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240112094851
FACILITY NAME:INNOVATIVE CENTERFACILITY NUMBER:
374602610
ADMINISTRATOR:RONALD FABIANFACILITY TYPE:
775
ADDRESS:7464 UNIVERSITY AVENUETELEPHONE:
(619) 461-0914
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:60CENSUS: 54DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Domingo Cuison, DirectorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
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9
staff not meeting client's incontinence care
INVESTIGATION FINDINGS:
1
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5
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9
10
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12
13
Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Domingo Cuison, Director. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Director.

On January 12, 2024, a complaint was received regarding staff not meeting the client's incontinence care. The purpose of this investigation was to determine the validity of the allegation and take appropriate actions if necessary. The following were reviewed and observed as part of the investigation: Residents' records, and a tour of the facility.

Allegation: Staff not meeting client's incontinence care. The investigation found that staff members had followed policy and procedures for changing incontinence wear. Client 1 (C1) did not have a condition that would need to change or check more than the required every 2 hours. Before C1 left the facility an incontinence change/check was done before being transported by MTS.
Continued on 9099C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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 2
Control Number 08-AS-20240112094851
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: INNOVATIVE CENTER
FACILITY NUMBER: 374602610
VISIT DATE: 01/19/2024
NARRATIVE
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Based on the findings of this investigation, the allegation is found to be unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Domingo Cuison, Director. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Director and her signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2