374603734-11-17-2023-08-AS-SJAB-CY4362-20231130165736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603734
Report Date: 11/17/2023
Date Signed: 11/17/2023 01:35:28 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
10/17/2023 and conducted by Evaluator Mark Mandel

COMPLAINT CONTROL NUMBER: 08-AS-20231017112640

FACILITY NAME:	SHINING STAR ADULT DAY CARE INC		FACILITY NUMBER:	374603734
ADMINISTRATOR:	GRIGGS, LAURA CASAS		FACILITY TYPE:	775
ADDRESS:	333 E STREET		TELEPHONE:	(619) 651-7446
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	30	CENSUS: 30	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Director Laura Griggs		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Lack of supervision resulting in an AWOL.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mark Mandel and Licensing Program Manager (LPM) Simon Jacob conducted an unannounced visit to follow-up on a complaint investigation regarding the above-mentioned allegation. LPA and LPM identified themselves and were granted entry by Staff, Lizbethe Jimenez,and met with Director Laura Griggs. LPA and LPM stated the purpose of the visit and discussed the elements of the complaint with Director Laura Griggs. LPA delivered the investigative finding to Director Griggs.

During today's visit, LPA observed consumers in care and interviewed staff and alledged victim.

On 10/17/2023, the Department received a complaint alleging that facility staff demonstrated a lack of supervision resulitng in AWOL of a consumer. The Department’s investigation consisted of facility visits, record reviews, and interviews with staff and consumers.
(Cont. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Mark Mandel
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

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-20231017112640

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: SHINING STAR ADULT DAY CARE INC	FACILITY NUMBER: 374603734
	VISIT DATE: 11/17/2023

NARRATIVE

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(Cont. from LIC9099)

On 10/13/2023, Consumer 1(C1) arrived at the facility in the morning and was initially at baseline. Later in the day, C1 became agitated by Consumer 2 (C2) and was observed by Staff 1 (S1) running out of the facility. Staff 1 (S1) and Staff 2 (S2) followed C1 out of the facility and observed C1 to engage in dangerous behaviors.

S2 then contacted the police to assist in the search for C1 and also contacted the Administrator, Staff 3 (S3) and C1's care provider to inform them of the incident. S1 then contacted Staff 4 (S4) to assist in the search of C1. S2 also employed the help of Staff 5 (S5) in an attempt to search for C1. S1 and S2, found C1 hiding next to trash cans. S2 then notified the police of C1’s location. C1 was put on a 51/50 hold and paramedics transported C1 to the the hospital. The facility followed all aspects of their Absentee Notification Plan.

Interviews with consumers and staff did not corroborate the allegation that facility staff demonstrated a lack of supervision resulting in an AWOL.

Based on the evidence obtained and reviewed, the allegation that facility staff demonstrated a lack of supervision resulting in an AWOL is Unsubstantiated, as the preponderance of evidence standard was not met. An exit interview was conducted with Director Griggs, and a copy of this report was provided to Ms. Griggs.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Mark Mandel
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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