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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602881
Report Date: 11/18/2022
Date Signed: 02/02/2023 10:38:23 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
07/13/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210713121721
FACILITY NAME:A PLACE OF GRACE INC CANTON DRIVEFACILITY NUMBER:
374602881
ADMINISTRATOR:HAINES, SHANTAFACILITY TYPE:
735
ADDRESS:7312 CANTON DRTELEPHONE:
(619) 467-7367
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY:6CENSUS: 3DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jamie Duey- Toscano, CaregiverTIME COMPLETED:
11:08 AM
ALLEGATION(S):
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Staff did not adequately supervise residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Jamie Duey- Toscano, Caregiver to deliver findings on the above-mentioned allegation.

LPA conducted the initial investigation visit on July 23, 2021, and was able to interview clients, facility staff, and outside sources. LPA also reviewed records and conducted a physical inspection of the facility. It was alleged staff did not adequately supervise residents in care. On July 11, 2021 an incident took place between Client 1 (C1) and C2. C1 punched C2 in the face because they were upset about the air conditioning not being on in the facility.

This is an amended report from November 18, 2022
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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-20210713121721
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: A PLACE OF GRACE INC CANTON DRIVE
FACILITY NUMBER: 374602881
VISIT DATE: 11/18/2022
NARRATIVE
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Interviews revealed the sheriffs were called and they removed C1 from the facility after the incident. Interviews revealed that staff are trained at time of hire on supervision and the staff know they have to do rounds and supervise the clients at all times.

Interviews revealed C1 has a history of being aggressive per their Individual Program Plan (IPP) but had not been aggressive within the last year.
Interviews revealed staff do rounds every 30 minutes and check on the clients when they are in their rooms. The facility knew about the C1s behavior, and there was no behavior plan in place for C1 due to C1 not having any aggressive incidents in over a year period. Therefore there was nothing for staff to mitigate. The staff complete rounds every 30 minutes because that's what's expected of the caregivers.

Based on the evidence obtained from interviews, records review, and observation the complaint allegation is found to be unsubstantiated.

An exit interview was conducted with Jamie Duey- Toscano, Caregiver and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.





This is an amended report from November 18, 2022
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2