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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603587
Report Date: 11/08/2023
Date Signed: 11/09/2023 07:33:22 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
10/13/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20231013124449
FACILITY NAME:CHANCELLOR HOMEFACILITY NUMBER:
374603587
ADMINISTRATOR:ASTRID GARCIAFACILITY TYPE:
735
ADDRESS:13904 CHANCELLOR WAYTELEPHONE:
(858) 842-4534
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:4CENSUS: 3DATE:
11/08/2023
UNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Direct Support Staff (DSP) D'ana NunezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff not preventing a resident from harming other residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to conclude a complaint investigation regarding the above-mentioned allegation. LPA Correia met with DSP Nunez, identified herself, and explained the purpose of the visit.

The Department’s investigation consisted of facility and resident record reviews, client, and staff interviews, as well as LPA observations.

It was alleged that facility staff do not prevent clients from harming other clients. An interview conducted with Client 1 (C1) revealed that Client 2 (C2) engaged in behaviors that are triggering for other clients in care and staff are not always able to control C2. C1 also revealed they had heard of C2 being assaultive towards other clients and was concerned that C2 would interfere with their progress while residing at the facility. An additional interview conducted with Client 3 (C3) also revealed facility staff redirect C2 during behavioral outbursts, however C2 can be very quick and is not always able to be redirected.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
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-20231013124449
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: CHANCELLOR HOME
FACILITY NUMBER: 374603587
VISIT DATE: 11/08/2023
NARRATIVE
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Interviews with facility staff revealed C2 has resided at the facility for approximately 8 years, is non-verbal, and has 24-hour supervision. Staff interviews revealed C2’s main trigger is certain types of food. Staff interviews corroborated C2 does not assault the other clients, but rather the other clients intentionally provoke C2 by taunting him with food. An interview with Staff 1 (S1) revealed they have video of an occasion when C2 tried to get to food and bumped or brushed into another client who then assaulted C2. LPA Correia observed footage of the incident between C2 and another client that corroborated the staff statements. A facility records review revealed Special Incident Reports (SIRs) that facility staff submitted to Community Care Licensing (CCL) that also corroborated staff statements and revealed no indication of C2 being assaultive towards other clients.

Due to lack of corroborating evidence, the finding regarding the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA conducted an exit interview with DSP Nunez and was provided a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2