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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603818
Report Date: 11/18/2022
Date Signed: 11/18/2022 02:22:09 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
10/04/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20221004142523
FACILITY NAME:EUBANK CASTLEFACILITY NUMBER:
374603818
ADMINISTRATOR:ANETA STANEK DE LAFACILITY TYPE:
735
ADDRESS:1528 SANGAMON AVENUETELEPHONE:
(619) 825-6473
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 4DATE:
11/18/2022
UNANNOUNCEDTIME BEGAN:
12:11 PM
MET WITH:Monica Mc Dade, Program ManagerTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident went AWOL due to lack of supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Monica Mc Dade, Program Manager 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 the resident went AWOL due to lack of supervision. Interviews revealed on October 3, 2022 staff and four clients went to a nearby casino. Interviews revealed while at the casino Client 1 (C1) wanted to smoke a cigarette, so the staff took C1 outside to smoke. Staff 1 (S1) then left C1 outside smoking while they went to the bathroom. Once S1 returned to where they left C1, they were no where to be found. S1 started looking for C1 and requested the help of the security guards on the premises.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
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 3
Control Number 08-AS-20221004142523
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: EUBANK CASTLE
FACILITY NUMBER: 374603818
VISIT DATE: 11/18/2022
NARRATIVE
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There were 3 security guards searching for C1 while staff was with the other 3 clients. After about an hour and a half, one of the security guards found C1 in the car with an unknown person. The security guard called S1 and they met up so they can get C1. The security guards called emergency services (EMT) to check C1. While checking C1 out, they determined that C1's blood pressure was high and C1 admitted to smoking methamphetamines. Interviews revealed that C1 admitted to drinking coffee, smoking cigarettes and smoked drugs from a pipe with this unknown person. The security guards called for emergency transport and they took over an hour to get to the casino so S1 took C1 to a nearby hospital after leaving the casino. Once at the hospital C1 was assessed and admitted to the hospital. C1 has a history of AWOL'ng and should not have been left unsupervised. Interviews revealed S1 admitted to leaving the client unsupervised.

Based on the evidence obtained from interviews, records review, the complaint allegation is found to be substantiated; as the preponderance of evidence proves the alleged violation occurred.

An exit interview was conducted with Monica MC Dade, Program Manager 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: 11/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20221004142523
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: EUBANK CASTLE
FACILITY NUMBER: 374603818
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/28/2022
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision:
The licensee shall provide care and supervision as necessary to meet the client's needs.This requirement is not met as evidenced by
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Licensee gave staff 1 a verbal warning regarding leaving C1 unattended. Licensee will provide trasining to staff on Proper supervision while out in the community by a behavior consultant.
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On October 3, 2022 1 out of 4 clients were left unsupervised. This poses an immediate health and safety risk to cleints in care.
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POC due by 11/28/2022. Licensee will submit training materials & signatures of staff to CCLby POC date.
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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: 11/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3