374603693-9-13-2024-08-AS-JLOT-D9JKMD-20240928080122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603693
Report Date: 09/13/2024
Date Signed: 09/13/2024 06:55:24 PM

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
08/30/2024 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20240830165001

FACILITY NAME:	KALEA HOUSE		FACILITY NUMBER:	374603693
ADMINISTRATOR:	LAURA GARCIA		FACILITY TYPE:	735
ADDRESS:	1312 SAN MIGUEL AVENUE		TELEPHONE:	(619) 303-9108
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	4	CENSUS: 3	DATE:	09/13/2024
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Caregiver, Desiree Castro		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver the findings of the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Caregiver, Castro.

On August 30, 2024, Community Care Licensing (CCL) received a complaint alleging staff issued an unlawful eviction notice to Client 1 (C1) [a LIC811 Confidential Names List was provided to staff to identify C1]. It was specifically alleged that C1 was not allowed to return to the facility after a hospital visit on August 28, 2024. During the investigation, LPA reviewed C1’s records including the admission agreement, physician’s report, medical assessments, and Individual Program Plan (IPP). The admission agreement disclosed that C1 was admitted into the facility on August 26, 2024. According to the medical records and IPP, C1 was conserved, and diagnosed with autism, mild mental intellectual disability, self-injurious behavior, and refractory seizures.
(continue at LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20240830165001

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: KALEA HOUSE	FACILITY NUMBER: 374603693
	VISIT DATE: 09/13/2024

NARRATIVE

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Continue from LIC9099

Two days after admission, on August 28, 2024, C1 experienced a mental health crisis incident at the facility that required staff to activate 911 to request emergency personnel dispatchers and first responders. C1 was assessed and considered a danger to themselves and/or others and was transported on a 5150 hold (California's Welfare and Institutions Code allows for the involuntary psychiatric detention of an adult for up to 72 hours). Based on the review of the details of the LIC624 incident report submitted to CCL disclosed no violations against Title 22 regulations. Staff properly followed C1’s service care plan which included proposed de-escalation strategies for physical aggression, self-injurious behavior, and property destruction. In addition, facility staff completed reporting requirements as required by Title 22 regulations. During interviews with staff and outside sources, it was disclosed that C1’s reporting party/conservator did not authorize C1 to be discharged back to the facility from the hospital due to safety concerns. C1’s placement agency and conservator determined that a higher level of care facility was required to meet C1's needs.

Based on LPA's interviews, observations, and records reviews there was insufficient corroborating evidence to support that facility staff issued an unlawful eviction to C1. Therefore, the unlawful eviction allegation is unsubstantiated.

No violations were issued during today’s visit.

An exit interview was conducted with Caregiver, Desiree Castro, to whom a copy of this report, LIC811 Confidential Name list, and the Licensee/Appeal Rights (LIC 9058 3/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024

LIC9099 (FAS) - (06/04)

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