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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602721
Report Date: 03/21/2024
Date Signed: 03/21/2024 10:46:40 AM

Substantiated


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
03/20/2024 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20240320142914
FACILITY NAME:INDEPENDENCE FIRST, INC.-LEGHORNFACILITY NUMBER:
374602721
ADMINISTRATOR:AGUINALDO, ELSIEFACILITY TYPE:
735
ADDRESS:697 LEGHORN AVETELEPHONE:
(619) 262-2938
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 0DATE:
03/21/2024
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Elsie AguinaldoTIME COMPLETED:
10:54 AM
ALLEGATION(S):
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Facility was in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced Complaint Visit. LPA introduced himself and discussed the purpose of the visit with Administrator Elsie Aguinaldo.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of records review and LPA observation.

It was reported to CCL that the facility was in disrepair. It was alleged that the ceiling inside the facility was molded and a health and safety risk to clients in care. LPA Serrano visited the facility on March 21, 2024. LPA entered the facility and immediately observed the hallway ceiling to be severely water damaged and molded. LPA also observed a roofer was on site working. The worker advised LPA that he was in the process of preparing the ceiling to be removed due to the extensive water damage. LPA spoke with the Licensee via telephone. The Licensee advised LPA that she submitted an Incident report to CCL regarding the damaged roof and the temporary relocation of the clients.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 3
Control Number 08-AS-20240320142914
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: INDEPENDENCE FIRST, INC.-LEGHORN
FACILITY NUMBER: 374602721
VISIT DATE: 03/21/2024
NARRATIVE
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The Licensee further stated that she has been in regular contact with her SDRC service coordinator and they are aware of the current situation at the facility.

The Licensee explained that during the recent onslaught of rain and storms the facility roof was damaged and began to leak water into the ceiling. Licensee stated that the roof needed to be removed and that the repairing could not begin until it stopped raining. Licensee stated that the roof and ceiling are currently being repaired with a completion date of March 24, 2024.

Based upon the foregoing, the above listed allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and is noted on the attached LIC 9099-D.

An exit interview was conducted with Elsie Aguinaldo and a copy of this report and Licensee/Appeal Rights (LIC9058, 3/22) were provided to Elsie Aguinaldo whose signature below confirms receipt of documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240320142914
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: INDEPENDENCE FIRST, INC.-LEGHORN
FACILITY NUMBER: 374602721
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2024
Section Cited
CCR
80087(a)
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BUILDINGS AND GROUNDS. (a) 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. This requirement is not met as evidenced by:
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Licensee stated that the roof and ceiling is currently being repaired with a completion date of 3/24/24. LPA will return to facility on 3/25/24 to clear POC
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Based on LPA observation and outside source the licensee did not keep facility ceiling and roof in good repair which posed a a health and safety risk to clients in care.
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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: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3