374603752-6-29-2021-08-AS-IESA-C6EVJ6-20210831162811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603752
Report Date: 06/24/2021
Date Signed: 06/29/2021 01:54:28 PM

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
06/15/2021 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20210615154416

FACILITY NAME:	ISLAND GROVE GUEST HOME II		FACILITY NUMBER:	374603752
ADMINISTRATOR:	RAMIREZ, CARMINDA		FACILITY TYPE:	740
ADDRESS:	12624 WILLOW ROAD		TELEPHONE:	(619) 454-3166
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY:	12	CENSUS: 8	DATE:	06/24/2021
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	House Manager, Kyle Hernandez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Neglect to residents resulting in serious medical conditions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA Correia met with House Manager Kyle Hernandez and explained the purpose for the visit.

The Department’s investigation consisted of staff, residents, and outside source interviews, and a facility tour.
It was alleged that the Licensee was not running the Air Conditioning (AC) on June 15, 2021. An outside source revealed the facility was only running two small AC window units that were low functioning. The interview also revealed the facility was extremely hot and the residents appeared sweaty and lethargic possibly on the verge of heat stroke or exhaustion. During LPA’s facility tour, on June 16, 2021, LPA observed air condition units in all 6 (including vacant rooms) of the resident room’s windows (all set at different temperatures), and another unit in the common area of the facility was set at 76 degrees Fahrenheit. Interviews with six resident interviews revealed no level of discomfort in temperature at the facility at any point in time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

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-20210615154416

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: ISLAND GROVE GUEST HOME II	FACILITY NUMBER: 374603752
	VISIT DATE: 06/24/2021

NARRATIVE

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Two residents interviewed, while in their bedrooms, revealed they did not have their AC units running because they felt the temperature was perfect, and are able to turn them on at their discretion. An interview with Licensee Carminda Ramirez revealed, at the time of the allegation, medical personnel were present at the facility to assist a resident in care, during that time the facility door was left open possibly allowing the cool air out and the facility temperature to rise.

Based on interviews, and observations the finding regarding the above allegation was determined to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Correia conducted an exit interview with House Manager Hernandez and a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) was provided to House Manager Hernandez via email. An electronic email read receipt confirms the documents were received

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2021

LIC9099 (FAS) - (06/04)

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