374603529-3-10-2023-08-AS-DPOL-CQET79-20230330142821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603529
Report Date: 03/10/2023
Date Signed: 03/10/2023 03:37:00 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, 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
10/06/2022 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20221006092218

FACILITY NAME:	MISSION VILLA EAST		FACILITY NUMBER:	374603529
ADMINISTRATOR:	ROSEMARIE LIMPIN		FACILITY TYPE:	740
ADDRESS:	2337 CAMINO DEL RIO SOUTH		TELEPHONE:	(619) 501-1788
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92108
CAPACITY:	6	CENSUS:	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Alexander Limpin		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Absence of Supervision

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Caregiver, Teresita Yap. Administrator, Amsal Engdaw join the meeting via telephone.

The Department investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, multiple interviews with staff and outside sources, and records review.

On October 6, 2022, Community Care Licensing (CCL) received a complaint alleging that facility staff left residents unsupervised for extended periods of time. It was specifically alleged that residents were left unsupervised because only one (1) staff member was scheduled to work at the same shift time at two different facilities, located adjacent to each other. The two facilities were licensed, owned, and operated by the same management and staff.
(Continue at LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20221006092218

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: MISSION VILLA EAST	FACILITY NUMBER: 374603529
	VISIT DATE: 03/10/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continue from LIC9099)

On October 13, 2022, during a visit at the facility, two (2) caregivers were observed present at the facility. During interviews, residents indicated that staff were always present at the facility when they called out for assistance. Residents consistently stated they did not recall any time when they did not observe caregivers at the facility. In addition, outside sources indicated that during their visits they consistently observed at least two (2) caregivers present at the facility. On October 13, 2022, a collateral visit was also conducted at the adjacent facility and direct observations confirmed that three (3) staff were working at the facility. A detailed review of the personnel report and staffing schedules for the period from September 1, 2022 to October 13, 2022, for both facilities indicated that at least one (1) – two (2) staff members were scheduled to work at each of the facilities. Interviews with staff consistently stated that it was standard practice to have an extra staff member scheduled as a “floater” to work at both facilities. The floater staff was used at both facilities to provide coverage during staff breaks and lunch periods. The floater system ensured that at least one staff member was always present at each of the facilities to supervise the residents. The review of the staff schedule confirmed the floater system was employed during the time period in question.

Due to a lack of evidence, this allegation is deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violations occurred.

An exit interview was conducted with Caregiver, Yap and Administrator, Engdaw, a copy of this report, and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2