374603621-4-29-2025-08-AS-RCLK-DG9936-20250430230013

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603621
Report Date: 04/23/2025
Date Signed: 04/29/2025 10:53:49 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
02/19/2025 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20250219165013

FACILITY NAME:	ACI		FACILITY NUMBER:	374603621
ADMINISTRATOR:	TAMARA ANDERSON		FACILITY TYPE:	775
ADDRESS:	296 H STREET, #101		TELEPHONE:	(619) 409-4100
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	90	CENSUS: 53	DATE:	04/23/2025
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Tamara Anderson		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Lack of supervision resulted in client on client 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 Administrator Tamara Anderson 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 records review, interviews with staff, clients, outside sources and outside agency.

It was alleged that lack of supervision in the adult day program (ADP) resulted in client on client abuse. It was reported that Client 1 (C1) was punched in the rib area by Client 2 (C2) while at the ADP. LPA interviewed C1 on February 27, 2025. C1 stated that they have attended the ADP for five years. C1 stated that they "like" the ADP including the clients. LPA asked C1 about the allegation of C2 hitting them. C1 stated C2 kissed C3. C2 hit me on Monday. C1 stated that they told staff that C2 hit them. C1 stated that C2 only hit them one time on the side. LPA records review revealed C1's ADP admit date was March 5, 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

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 4

Control Number 08-AS-20250219165013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ACI	FACILITY NUMBER: 374603621
	VISIT DATE: 04/23/2025

NARRATIVE

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LPA interviewed Client 2 (C2) on February 27, 2025. C2 stated that they have been attending the ADP for many years. C2 stated that they like the ADP and all of the clients are their friends. C2 stated that they know C1 and C2 tried to be friends with C1 but C1 doesn't want to be friends with them by the way C1 acts. C2 stated that C1 ignores them whenever they say "hi" to C1. C2 stated that their ex-partner (C3) dated C1. C2 stated that they are no longer dating C3 and they do not care if C1 dates C3. C2 stated that they use to "hang out" with C1 many years ago at another program. C2 denied ever hitting C1 and also denied that C1 ever hit them. C2 explained that they do not ride the bus and they are not in C1's ADP group so they are never around the same area. C2 further stated that they would like to be friends with C1 again but C1 does not want to be friends with them.

LPA interviewed Client 3 (C3) at the ADP on February 27, 2025. C3 stated that they have attended the ADP since 2017. C3 stated C2 is my partner. C3 stated that C2 is friendly with all of the clients. C3 stated that C2 never punched or hit C1. C3 stated that C1 never told them that C2 hit C1. C3 further stated that they are still friends with C1 but they do not know if C1 and C2 are friends.

LPA interviewed Staff 1 (S1) on February 27, 2025. S1 stated that they have worked at the ADP for three years. S1 stated that they work closely with all of the clients including C1. S1 stated that C1 and C2 are cordial with each other. S1 stated that C1 was upset with C2 because C3 "broke up" with C1. S1 stated that they have never witnessed C2 become violent. S1 stated that C1 always complains that their side hurts, when C1 has asthma C1 starts complaining about their side hurting.

LPA interviewed Staff 2 (S2) on April 23, 2025. S2 stated that they recently held a meeting with C1's social worker and care provider due to recent events involving C1. S2 stated that approximately two weeks ago C1 accused C2 of breaking into their house. S2 called C1's social worker and care provider to advise them of the accusation. S2 stated that both the social worker and care provider were in agreement that it could not have happened and it was a false allegation. S2 stated that after the false accusation C1 tried to provoke C2 at the ADP. C2 was seated and C1 stood over C2 and made aggressive gestures towards C2. ADP staff directed C1 to sit on the opposite side of the room to de-escalate the situation. S2 stated that a meeting was held with ADP staff and C1's team. S2 stated that it was decided that C1 be transferred to a different Day Program to prevent any future incidents.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20250219165013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ACI	FACILITY NUMBER: 374603621
	VISIT DATE: 04/23/2025

NARRATIVE

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LPA interviewed Outside Source 1 (OS1) who stated that the issues with C1 and C2 revolve around C3 who dated both clients. OS1 stated that C3 bothered C1 a lot. OS1 stated that in February C1 was admitted to the hospital with a pneumonia diagnosis and that is where C1 complained of a bruised rib and stated that C2 punched them. OS1 stated that both clients are jealous of each other due to C3 dating both of them. OS1 stated that C1 recently accused C2 of breaking into their home and OS1 advised C1 that C2 did not and could not have broken into the facility. OS1 stated that C1 is getting older and it is affecting their cognitive functioning. OS1 stated that it was decided by C1's team that C1 should be moved to a different Day Program.

LPA interviewed Outside Source 2 (OS2) who stated that she has known C2 for over 10 years. OS2 stated that C2 is "super sweet" and C2 evades any issues. OS2 stated that C2 is not aggressive whatsoever. OS2 stated that the worst thing C2 does when they are in a bad mood is curse, but that rarely happens. OS2 stated that when C2 is at the day program they are very helpful and sweet with both clients and staff. OS2 stated that when C2 is upset they just "shut down" OS2 further stated that she casually asked C2 about C1 to find out what occurred and C2 simply replied that they just leave C1 alone since C1 doesn't like them.

LPA interviewed Outside Agency (OA) who stated that they are familiar with both clients (C1 and C2) since they are both on their caseload. OA stated that C1 has made a few false allegations in the past. OA stated that C1 recently accused C2 of breaking into their house, which they know is not true. OA stated that this is the first ADP that C1 has ever attended while on their caseload. In regards to C2, OA stated that they have not received any reports or issues involving C2. OA stated that this is the first report they have received in two years involving C2. OA stated that they have not witnessed or heard of C2 acting out with aggression or violence. OA further stated that the ADP is a "big, open space" so staff would have witnessed the incident if it occurred in the facility.

LPA interviewed the Administrator (ADM) who stated that C1 and C2 were not in a group together and they arrive to the ADP at different times, so the alleged incident could not have occurred. ADM stated that the issue between C1 and C2 is a result of C3 dating both of them. C1 began dating C3 during a "break-up" period with C2. ADM stated that C3 then began dating C2 again which upset C1. C1 then told their care provider that C2 hit them. ADM stated that C1 had never told ADP staff that C2 hit them.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20250219165013

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ACI	FACILITY NUMBER: 374603621
	VISIT DATE: 04/23/2025

NARRATIVE

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The investigation indicates a lack of evidence to support the allegation of lack of supervision resulted in client on client abuse. Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met.

An exit interview was conducted with Tamara Anderson. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Tamara Anderson whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025

LIC9099 (FAS) - (06/04)

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