374603236-2-5-2021-08-AS-DPOL-BYGTGC-20210222134256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603236
Report Date: 02/05/2021
Date Signed: 02/05/2021 11:51:23 AM

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
04/10/2020 and conducted by Evaluator Jonathan C Pineda

COMPLAINT CONTROL NUMBER: 08-AS-20200410102455

FACILITY NAME:	ROXIES ELDERLY HOMES I		FACILITY NUMBER:	374603236
ADMINISTRATOR:	TERESITA ROXAS		FACILITY TYPE:	740
ADDRESS:	290 HOLIDAY WAY		TELEPHONE:	(760) 722-5920
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY:	6	CENSUS: 4	DATE:	02/05/2021
		UNANNOUNCED	TIME BEGAN:	11:04 AM
MET WITH:	Teresita Roxas, Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff are using illegal drugs while working at the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jonathan Pineda conducted an unannounced complaint tele-visit to deliver findings on the above allegation. The visit was conducted via a tele-visit due to COVID-19. LPA identified himself to Tersita Roxas, Administrator and stated the purpose of the visit.

The Department's investigation consisted of observations, interviews with staff, residents, and outside sources.

It was alleged that the facility staff are using illegal drugs while working at the facility. Interview with Staff 1, (S1) (See Confidential Names List) revealed that an outside source applied for employment at their facility but was not hired because they did not pass DOJ clearance. Interview with an outside source revealed that they did not have intimate knowledge of staff working at the facility and did not provide any corroborating evidence pertaining to the allegation. Interviews revealed that three (3) out of three (3) residents did not provide any corroborating information pertaining to the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

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-20200410102455

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: ROXIES ELDERLY HOMES I	FACILITY NUMBER: 374603236
	VISIT DATE: 02/05/2021

NARRATIVE

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Three (3) out of three (3) facility staff interviewed all denied using any illegal drugs or observing any facility staff using illegal drugs. Investigation and observations revealed there was not enough evidence to prove or disprove that the caregivers were using or had used illicit drugs.

Based on observations, review of records, interviews, and outside sources, it is determined that the allegation is UNSUBSTANTIATED. There is not a preponderance of the evidence to prove the allegation occurred.

An exit interview was conducted with Teresita Roxas, Administrator. A copy of this report LIC 9099 along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Teresita via email. An electronic email read receipt confirms the documents were received.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C Pineda	TELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

LIC9099 (FAS) - (06/04)

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