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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602941
Report Date: 12/21/2023
Date Signed: 12/21/2023 01:23:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2020 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20200923122135
FACILITY NAME:HJJ HOME #1FACILITY NUMBER:
374602941
ADMINISTRATOR:BOYER, HOWARD D.FACILITY TYPE:
735
ADDRESS:28441 MEADOW GLEN WAY WESTTELEPHONE:
(760) 580-8575
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:4CENSUS: 4DATE:
12/21/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director Howard BoyerTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
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9
Staff speaks inappropriately towards resident
INVESTIGATION FINDINGS:
1
2
3
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5
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9
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12
13
Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to continue a complaint investigation on the above-mentioned allegation. LPA identified herself and discussed the purpose of the visit with Director Howard Boyer.

On September 23, 2020, Community Care Licensing (CCL) received a complaint alleging clients were spoken to inappropriately by staff. During investigation, LPA Strong collected pertinent client records as well as facility documentation and conducted interviews.

According to the allegation, on an unknown date, Staff 1 (S1) spoke to Client 1 (C1) in an aggressive manner. According to C1’s Physician Report dated December 12, 2022, C1 can communicate and is able to follow instruction. Interview with C1 did not reveal any information to corroborate that they were treated inappropriately. Interview with additional clients revealed that there was no knowledge any recent incidents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
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-20200923122135
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: HJJ HOME #1
FACILITY NUMBER: 374602941
VISIT DATE: 12/21/2023
NARRATIVE
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 Interviews with staff present during the time in question did not reveal any additional information. Interview with outside source did not reveal any information to corroborate that this incident occurred.

Based on LPA's interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Director Howard Boyer, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2