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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603439
Report Date: 11/08/2021
Date Signed: 11/08/2021 04:38:33 PM



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
06/10/2021 and conducted by Evaluator Laarni Santiago
COMPLAINT CONTROL NUMBER: 08-AS-20210610115951
FACILITY NAME:CASA DE MANANAFACILITY NUMBER:
374603439
ADMINISTRATOR:JOHNSTON, ROBERTFACILITY TYPE:
740
ADDRESS:849 COAST BLVDTELEPHONE:
(858) 454-2151
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:249CENSUS: 202DATE:
11/08/2021
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Gracie Quihuis, Director of Health ServicesTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility has no Administrator


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Laarni Santiago conducted an unannounced visit to conduct an investigation into the above listed complaint allegations. LPA was granted entry into the facility and met with Director of Health Services, Gracie Quihuis, to whom she explained the reason for the visit.

Community Care Licensing (CCL) has investigated the above listed allegation. The investigation consisted of a tour of the facility, review of facility records, and interview of facility staff.

It was alleged that the facility haven't had an Administrator for the last two months since the last previous Administrator left on or around April 2021. Interviews conducted with staff revealed that there was an Interim Administrator that oversaw the facility pending hire of a new Administrator. LPA reviewed the Interim administrator's records and verified that they meet requirements as an administrator. Interviews conducted with staff also confirmed that they observed the interim administrator work the floor on some days and were able to carry out day-to-day administrator responsibilities. Currently, there is a new assigned administrator in the facility who was hired on June 28th, 2021.




Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
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-20210610115951
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: CASA DE MANANA
FACILITY NUMBER: 374603439
VISIT DATE: 11/08/2021
NARRATIVE
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Based on interviews conducted and records reviewed, the allegation has been deemed unsubstantiated, which means that although the allegation is valid or could have happened, there is not a preponderance of evidence that the alleged violation occurred.

An exit interview was conducted, and Licensee, was provided a copy of this report and Licensee Appeal Rights, via electronic mail, after conclusion of the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2