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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603211
Report Date: 12/16/2022
Date Signed: 12/16/2022 10:47:02 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
10/14/2022 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20221014153742
FACILITY NAME:MULLINS GUEST HOME IIFACILITY NUMBER:
374603211
ADMINISTRATOR:CAROLINO, ALEXFACILITY TYPE:
735
ADDRESS:219 S. ROYAL OAK DRTELEPHONE:
(619) 470-0869
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 6DATE:
12/16/2022
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Teodora SamonteTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Verbal Abuse
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Caregiver Teodora Samonte and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA interviews with clients and facility staff.

In response to the allegation, it was alleged that facility staff was verbal abusing and threatening a client (C1) [an LIC 811 Confidential Names List was provided to the facility representative to identify the client.]Interview with C1 on December 13, 2022 revealed they had no issues or concerns to discuss. C1 stated the last time C1 was yelled at by facility staff was over a month ago. C1 denied ever being threatened by facility staff. Interviews with several clients revealed no knowledge of any facility staff yelling or threatening clients.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
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-20221014153742
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: MULLINS GUEST HOME II
FACILITY NUMBER: 374603211
VISIT DATE: 12/16/2022
NARRATIVE
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Interview with outside agency revealed C1 advised them that the verbal abuse has stopped. Outside agency further stated that C1 has a history of making false allegations when they are upset with facility staff. Interviews with several facility staff members revealed no knowledge of any staff yelling or threatening clients. Interviews with management staff revealed no knowledge of staff members yelling or threatening clients. Management staff went on to state that the facility caregivers are passive and dedicated employees that have been employed at the facility for many years.

Based on LPA observations and interviews, we have found that the preponderance of the evidence standard has not been met, therefore, the allegation is found to be unsubstantiated.

An exit interview was conducted with Teodora Samonte and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to Teodora Samonte whose signature below confirms receipt of documents
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2