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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603693
Report Date: 01/20/2023
Date Signed: 01/20/2023 02:43:34 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
08/06/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210806121815
FACILITY NAME:KALEA HOUSEFACILITY NUMBER:
374603693
ADMINISTRATOR:LAURA GARCIAFACILITY TYPE:
735
ADDRESS:1312 SAN MIGUEL AVENUETELEPHONE:
(619) 303-9108
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 4DATE:
01/20/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura Garcia, AdministratorTIME COMPLETED:
10:36 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents were not adequately supervised.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Laura Garcia, Administrator to discuss the purpose of the visit. LPA’s visit consisted of delivering findings on the above-mentioned allegation.

LPA conducted a physical inspection of the facility, collected relevant records, and conducted interviews with clients, facility staff, and outside sources. It was alleged that residents were not adequately supervised. Interviews revealed that on or around August 16, 2021 Staff 1 (S1) was alone with the clients for their overnight shift. Interviews revealed early that morning around 1:00 am, Client 1 (C1) opened the front door and walked out the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
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 5
Control Number 08-AS-20210806121815
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: KALEA HOUSE
FACILITY NUMBER: 374603693
VISIT DATE: 01/20/2023
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
Interviews revealed C1 was in the next door neighbors yard when the staff got to them. The staff tried to convince C1 to return to the facility. Interviews revealed that C1 was newer to the facility and was not used to the home or staff. The staff admitted to being the only staff on site and that C1 had the potential to hurt themselves so the staff followed behind C1 and left the other 3 clients in the home asleep. Interviews revealed the police were called and they arrived at approximately 2:00 am.

Outside interviews revealed that C1 and S1 were observed to be in a front yard around 1am or so and that S1 was trying to get C1 to return to the facility. There were no other clients seen. The police were called and they addressed the incident. The administrator was also called and made aware of the incident.

Based on the evidence obtained from interviews, records review, the complaint allegation is substantiated.

An exit interview was conducted with Laura Garcia, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
08/06/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210806121815

FACILITY NAME:KALEA HOUSEFACILITY NUMBER:
374603693
ADMINISTRATOR:LAURA GARCIAFACILITY TYPE:
735
ADDRESS:1312 SAN MIGUEL AVENUETELEPHONE:
(619) 303-9108
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: DATE:
01/20/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura Garcia, AdministratorTIME COMPLETED:
10:36 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff can not communicate with residents.
Staff are not meeting the needs of a resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Laura Garcia, Administrator to discuss the purpose of the visit. LPA’s visit consisted of delivering findings on the above-mentioned allegation.

LPA conducted a physical inspection of the facility, collected relevant records, and conducted interviews with clients, facility staff, and outside sources. It was alleged that Staff can not communicate with residents. Interviews revealed that staff are bi-lingual and speak spanish and english. Interviews revealed that the clients speak and understand english. The interivews revelaed the staff are able to communicate with the clients and denied not being able to communicate with the clients.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20210806121815
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: KALEA HOUSE
FACILITY NUMBER: 374603693
VISIT DATE: 01/20/2023
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
It was alleged that staff are not meeting the needs of a resident. Interviews revealed that staff are meeting the clients needs. The staff have been trained on how to work properly with the clients. The clients require different types of care and the staff all know what to do. Interviews revealed that there was a client that was new at the facility and in the beginning the staff would walk the client around the property often. However as the client got acclimated to the facility home and the staff the behaviors weaned and there was not as many walks due to the client being able to adjust and do things in the home. Staff denied not meeting the clients needs and interviews revealed they are there to care for and meet the needs of each and every client.

Based on the evidence obtained from interviews, records review, the complaint allegations are unsubstantiated.

An exit interview was conducted with Laura Garcia, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20210806121815
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: KALEA HOUSE
FACILITY NUMBER: 374603693
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/23/2023
Section Cited
CCR
80065(a)
1
2
3
4
5
6
7
Personnel Requirements: Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times be employed in numbers necessary to meet such needs. This requirement was not met, as evidenced by:
1
2
3
4
5
6
7
Licensee had a review of what staff should do in a case when a client AWOL's. Licensee will have a training on supervision for staff by 01/23/2023 and will submit documentation and sign in sheet by POC due date.
8
9
10
11
12
13
14
Based on interviews, the licensee did not ensure residents needs were met for 4 of 4 persons in care, which posed a potential health and 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: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5