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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603818
Report Date: 09/26/2023
Date Signed: 09/26/2023 11:04:00 AM

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
08/25/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20230825095554
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: 5DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Monica McDade, Program AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff handled resident in a rough manner
Lack of supervision resulted in client on client altercation
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out the complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Monica McDade, Program Adminstrator, to discuss the purpose of the visit and elements of the complaint.

It was alleged that staff handled resident in a rough manner. The Department's investigation included interviews, review of pertinent records, and a review of the video recording of the incident. On August 23, 2023 there was an incident between Staff 1(S1) and Client 1 (C1). C1 alleges that S1 put their hands around C1 neck and choked them due to C1 taking S1s phone. Upon observation of the video LPA Holmes did not see S1 put their hands around C1s neck. The video shows C1 throwing items out of the fridge and throwing them away. The video also shows S1 grab their phone out of C1s hand.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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-20230825095554
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: EUBANK CASTLE
FACILITY NUMBER: 374603818
VISIT DATE: 09/26/2023
NARRATIVE
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It was alleged that lack of supervision resulted in client on client altercation. Interviews revealed the altercation between S1 and C1 resulted in C1 getting in an argument with C2. C2 hit C1 after C1 verbally attacked C2 and went after them. The staff were right there trying to diffuse the incident and C2 hit C1 in front of staff due to C1 not leaving out of C2s room. Interviews revealed staff was able to separate the two clients and no other incidents occurred.

An exit interview was conducted with Monica McDade, Program Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2