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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603752
Report Date: 02/23/2022
Date Signed: 02/23/2022 02:24:16 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
12/27/2021 and conducted by Evaluator Anna Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20211227110614
FACILITY NAME:ISLAND GROVE GUEST HOME IIFACILITY NUMBER:
374603752
ADMINISTRATOR:RAMIREZ, CARMINDAFACILITY TYPE:
740
ADDRESS:12624 WILLOW ROADTELEPHONE:
(619) 454-3166
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY:12CENSUS: 9DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Paul VegaTIME COMPLETED:
03:01 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful Eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kennedy conducted an unannounced complaint visit to deliver investigative findings regarding the above allegation. LPA identified herself and was invited in to the facility. LPA met with Paul Vega, assistant manager and discussed the purpose of today's visit.

During the investigation, LPA conducted interviews with internal and external sources and toured the facility.

The allegation that the facility evicted a resident unlawfully was based on a concern that a hospital was ready to release a resident and the facility staff did not allow the resident to return to the facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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 2
Control Number 08-AS-20211227110614
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: 02/23/2022
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
Interviews revealed that Individual 1 (I1) (see LIC811 for confidential names) was being released from another setting and was in need of urgent housing and care. I1’s responsible party resides out-of-state. The responsible party contacted the facility to see if they could care for I1. The facility representative agreed to assist the responsible party and allow I1 to come to the facility for a period of assessment. The responsible party and the facility wanted to determine if this facility would be a good home for I1.

I1 was sent to the hospital via 911 for behavioral concerns the first night I1 was at the facility. The following day the hospital released I1 who returned to the facility. I1 was sent to the hospital again the second night for the same behavioral concerns. Again, the hospital wanted to release I1 back to the facility the following day. The responsible party and the facility staff were not in support of I1 returning to the facility if I1 was being released that day. The hospital was informed that I1 would not be returning to the facility at that time.
The facility and I1’s responsible party did not have a completed and signed admission agreement as I1 was under assessment at the time I1 was sent to the hospital. Therefore, there was no violation of an agreement, and no unlawful eviction.

This complaint allegation is determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Therefore, the complaint has been dismissed.

This report was discussed with Paul Vega Assistant Manager. A copy along with Licensee Rights (01/2016) was emailed to the administrator at the conclusion of the visit. An electronic response confirms the receipt of these documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2