374602881-3-27-2025-08-AS-JROO-DFTUFS-20250417153312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602881
Report Date: 03/27/2025
Date Signed: 03/27/2025 09:33:30 AM

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
09/26/2022 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20220926152452

FACILITY NAME:	A PLACE OF GRACE INC CANTON DRIVE		FACILITY NUMBER:	374602881
ADMINISTRATOR:	HAINES, SHANTA		FACILITY TYPE:	735
ADDRESS:	7312 CANTON DR		TELEPHONE:	(619) 467-7367
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	6	CENSUS: 3	DATE:	03/27/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Staff Jamie Duey-Toscano		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Unsafe conditions in the facility led to resident sustaining a fracture

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Administrator Roman Price and Staff Jamie Duey-Toscano.

Throughout the investigation, the Department secured records and conducted interviews with external and internal sources.

It was alleged unsafe conditions in the facility led to a resident sustaining a fracture. On September 27, 2022, it was reported to the Department the facility was renovating a bathroom, and these conditions led to Client # 1 (C1) falling and sustaining a fracture.

Review of C1’s Physician’s Report (LIC 602), dated October 4th, 2021, revealed a primary diagnosis of Schizo-affective disorder, and a secondary diagnosis of hypertension, and hyperlipidemia.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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-20220926152452

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: A PLACE OF GRACE INC CANTON DRIVE	FACILITY NUMBER: 374602881
	VISIT DATE: 03/27/2025

NARRATIVE

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The LIC 602 noted C1 was ambulatory, was able to ambulate without assistance, was able to care for own toileting needs, and able to leave the facility unassisted. Motor impairment was noted for C1, as history of Extrapyramidal Symptoms.

Interviews with internal and external sources confirmed C1 was able to ambulate without assistance, did not require the use of Assistive Ambulatory Device (ADDs), but did display stiff lower extremities. During the time in question, the bathroom primarily used by C1 was under renovation. Staff maintained the bathroom closed when renovations were not occurring, and clients were redirected to use a different bathroom. This additional bathroom was in a different client’s bedroom, Client # 2 (C2). Review of the Incident report submitted by the facility, along with interviews, confirmed C1 fell in C2’s bedroom, and it was believed C1 had tripped on cords, or a rug.

Interviews revealed C2 had television and other cords laying in front of the entrance to the bathroom. Staff confirmed management was notified of this hazard. Staff and management had repositioned the cords, encouraged C2 not to place the cords in front of the doorway, but C2 would sometimes place the cords in front of the bathroom door. A telephone interview was attempted with C1, but C1 was not able to recall ever residing at this facility. C2 recalled C1, but did not recall C1 falling in C2’s bedroom.

Based on the evidence obtained during the investigation, the allegation was unsubstantiated.

An exit interview was conducted with Staff Jamie Duey-Toscano. A copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided to Administrator Roman Price.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC9099 (FAS) - (06/04)

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