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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602673
Report Date: 10/13/2023
Date Signed: 10/13/2023 02:29:44 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
07/30/2020 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20200730085217
FACILITY NAME:CASA ESTRELLA 11TH STFACILITY NUMBER:
374602673
ADMINISTRATOR:MICHELLE MUNOZFACILITY TYPE:
735
ADDRESS:1125 11TH STREETTELEPHONE:
(619) 651-1177
CITY:IMPERIAL BEACHSTATE: CAZIP CODE:
91932
CAPACITY:6CENSUS: 5DATE:
10/13/2023
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Michelle Munoz, AdministratorTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
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9
Staff hit client
Staff withheld medication from client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Michelle Munoz Administrator, to discuss the purpose of the visit and elements of the complaint.

On unspecified days, it was alleged that the staff hit a client. Interviews revealed Client 1 (C1) had a history of making false allegations. Interviews with staff revealed that C1 was verbally and physically aggressive with the staff and other clients. Interviews with the two staff involved denied they ever hit C1. Interviews with clients revealed staff had not hit them and they never saw staff hit C1. There were no witness statements to support the allegation that staff hit a client.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
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-20200730085217
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: CASA ESTRELLA 11TH ST
FACILITY NUMBER: 374602673
VISIT DATE: 10/13/2023
NARRATIVE
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It was alleged that staff withheld medication from a client. Interviews with staff revealed C1 would refuse their medications, especially when they were having a behavior. Interviews revealed staff gave clients their medications according to how the doctor prescribed the medications. Interviews with clients revealed they got their medication daily and timely. There were no witness statements to support the allegation that the staff withheld the medication from the client.
The allegations were therefore determined to be unsubstantiated, since the preponderance of evidence standard was not met.

An exit interview was conducted with Michelle Munoz Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2