374602872-12-13-2021-08-AS-DPOL-CABMZE-20220103090259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602872
Report Date: 12/02/2021
Date Signed: 12/13/2021 07:52:04 AM

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
03/02/2021 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20210302160248

FACILITY NAME:	BRISA DEL SOL		FACILITY NUMBER:	374602872
ADMINISTRATOR:	SALVADOR ANTON		FACILITY TYPE:	735
ADDRESS:	38133 HIGHWAY 94		TELEPHONE:	(619) 746-4664
CITY:	BOULEVARD	STATE: CA	ZIP CODE:	91905
CAPACITY:	4	CENSUS: 4	DATE:	12/02/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Caregiver, Alexandra Calderon		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Uncleared staff worked at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation visit at the facility. LPA was greeted at the front entrance by Caregiver, Alexandra Calderon and granted entry after identifying herself. LPA Hamilton explained the purpose of the visit was to deliver findings for the above allegation.

The Department’s investigation consisted of records reviewed, interviews with staff and outside sources.

On March 02, 2021, it was alleged that during unspecified dates, but for the last three years staff 1 (S1- See LIC 811 Confidential Names List) was an uncleared staff (did not have required criminal background clearance) who worked at the facility. Interviews with multiple staff and Administrator disclosed there were no uncleared staff providing client care at the facility over the past three years. Interviews further revealed there was a previous staff with the same first name as S1 employed during the time in question with a background clearance.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

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-20210302160248

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: BRISA DEL SOL	FACILITY NUMBER: 374602872
	VISIT DATE: 12/02/2021

NARRATIVE

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Records reviewed including Department and facility personnel records confirmed the interview statements. Interviews with outside sources confirmed there were no personnel concerns at the facility during the time in question. Interviews with clients were not conducted as they were assessed as not qualified to be interviewed and had no relevant information to provide.

The Department has investigated the allegation listed above. Based on evidence obtained, including interviews and records reviewed the above allegation is unsubstantiated as the Department could not meet the preponderance of the evidence standard.

An exit interview was conducted with Caregiver and a copy of this report, LIC 811 (Confidential Names List) and Licensee/Appeals Rights (LIC 9058 01/16) was provided to the Licensee via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021

LIC9099 (FAS) - (06/04)

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