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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603824
Report Date: 04/27/2022
Date Signed: 04/27/2022 03:17:05 PM

Unsubstantiated


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
03/25/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20220325164322
FACILITY NAME:TIZON'S PRIME CARE INCFACILITY NUMBER:
374603824
ADMINISTRATOR:CALUMPONG, GRACEFACILITY TYPE:
735
ADDRESS:833 RANGEVIEW STREETTELEPHONE:
(619) 227-2010
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 5DATE:
04/27/2022
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lorna Rosales, CaregiverTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
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9
Resident got into a physical altercation with staff resulting in bruising.
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
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13
Licensing Program Analyst (LPA), Tiffany Holmes made an unannounced visit to close an investigation on the above mentioned allegation. LPA identified herself and disclosed the purpose of the visit. LPA met with Lorna Rosales, Caregiver and discussed the outcome of investigation. During the investigation, LPA toured the facility, conducted interviews and reviewed copies of facility records. It was alleged that the resident got into a physical altercation with staff resulting in bruising. Interviews revealed the client was scratched by a client at program. Interviews with staff denied any physical abuse or altercations with any clients at the facility. Interviews with clients revealed the staff are courteous and helpful. There haven't been any altercations or fights at the facility between staff and clients. Outside sources revealed there is no exact way of knowing where the bruise came from due to conflicting stories from the cleint. This agency has investigated the complaint alleging resident got into a physical altercation with staff resulting in bruising. Although, the allegation may have occurred and is valid, there is not a preponderance of evidence to prove the alleged violation occurred. As such, the finding for this complaint investigation is Unsubstantiated. An exit interview was conducted with Lorna Rosales, Caregiver, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Lorna Rosales, Caregiver
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
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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