<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603642
Report Date: 04/18/2022
Date Signed: 04/18/2022 04:16:58 PM

Substantiated


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
04/11/2022 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220411122856
FACILITY NAME:LOL - LIFE OF LIBERTY, LLCFACILITY NUMBER:
374603642
ADMINISTRATOR:MUNOZ, CLAUDIAFACILITY TYPE:
775
ADDRESS:320 N. HORNE STREETTELEPHONE:
(760) 433-5411
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:100CENSUS: 78DATE:
04/18/2022
UNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Claudia Munoz, Program DirectorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not ensure client was fed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Manager (LPM) Denise Powell and Licensing Program Analyst (LPA) Esther Miller conducted an unannounced visit to deliver findings for the above-mentioned allegation. LPA was granted entry by Gerald Hampton, Chief Executive Administrator, after identifying themselves. LPM and LPA discussed the purpose of the visit with Claudia Munoz, Program Director.

During the investigation, the Department reviewed facility and client records, outside source records, and conducted interviews with staff and outside sources. During today's visit, LPA briefly toured the facility and obtained records. It was alleged that staff did not ensure that client was fed.

[Continued on LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
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 3
Control Number 08-AS-20220411122856
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: LOL - LIFE OF LIBERTY, LLC
FACILITY NUMBER: 374603642
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2022
Section Cited
CCR
82076(f)(1)
1
2
3
4
5
6
7
FOOD SERVICES: (f) Clients shall be permitted to bring their own food to the day program. (1) ... the licensee shall ensure that the food service requirements specified in Sections 82076(c) and (d) are met. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee provided staff in-service training the same day as incident to remind staff to check backpacks and to verify meals eaten by clients. Facility created checklist for C1. All POC cleared; copies of in-service training submitted to CCLD.
8
9
10
11
12
13
14
Based on interview and record review, the licensee did not ensure that client was fed in 1 of 48 of clients, which poses a potential Personal Rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20220411122856
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: LOL - LIFE OF LIBERTY, LLC
FACILITY NUMBER: 374603642
VISIT DATE: 04/18/2022
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
Facility records and Program Director report that, on April 4, 2022 at approximately 9:00AM, Client 1 (C1) arrived at the facility with a backpack that contained their lunch, and usually leaves the day program at approximately 2:30PM. Program Director also said that lunch is usually eaten around 11:30AM. A review of outside source records revealed that C1 is able to eat without assistance. But, Program Director, stated that C1 requires assistance in taking out their lunch from their backpack, serving, and heating up C1's meal. An interview with Program Director revealed that C1 was inadvertently not fed lunch due to C1 requesting to use the restroom numerous times before and during lunch. C1 requested the restroom 5-6 times before 10:30AM and 9 times from 10:30AM to 11:15AM which, outside sources noted, is an avoidance behavior. Program Director also reported that during lunch, there were several events that required prioritization that led to staff not being aware that C1 was not fed. A Special Incident Report from the facility advising the Department that staff did not provide C1 with a meal during lunch, received on April 6, 2022, corroborates the described events of April 4, 2022 as well as outside source interviews.

Based on interviews and records review, the evidence obtained during the complaint investigation, the allegation that the licensee did not ensure that the client was fed is found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the allegation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Program Director. An exit interview was conducted with Program Director; LIC9099C, LIC9099D, the plan of correction, a copy of this report, and Licensee's Rights (LIC9058) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3