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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603968
Report Date: 04/06/2023
Date Signed: 04/06/2023 10:35:48 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2023 and conducted by Evaluator Charmaine Linley
PUBLIC
COMPLAINT CONTROL NUMBER: 08-CR-20230124131151
FACILITY NAME:A.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER:
374603968
ADMINISTRATOR:ROSAS, ELIZABETHFACILITY TYPE:
721
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:204CENSUS: 30DATE:
04/06/2023
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Lerone JenkinsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff handled child in a rough manner
INVESTIGATION FINDINGS:
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On April 6, 2023, at 10:05 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Lerone Jenkins, Protective Services Program Manager, of A.B. Jessie Polinsky Children’s Center, to discuss the investigative finding for the allegation noted above. LPA Charmaine Linley conducted an inspection of the facility on 01/25/2023 at 4:00 PM and no deficiencies were found. LPA Linley interviewed five staff (S1-5), interviewed one client (C1),and one County Social Worker (CSW1). LPA reviewed the following documents during the investigation: Staffing Worksheets, C1 Child History Summary and Virtual Assessment Team Screening Form, and Emergency Response Referral Information.

On 01/24/2023, Community Care Licensing received an allegation that staff handled C1 in a rough manner. It was reported that staff dug their nails into C1’s armpit during their last placement at the facility. Confidential interviews revealed conflicting statements. Confidential interview reported staff dug their fingernail into C1’s
***CONTINUED ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) -782-4968
LICENSING EVALUATOR NAME: Charmaine LinleyTELEPHONE: 951-202-1850
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023
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-CR-20230124131151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: A.B. JESSIE POLINSKY CHILDREN'S CENTER
FACILITY NUMBER: 374603968
VISIT DATE: 04/06/2023
NARRATIVE
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armpit but was not witnessed. Other conflicting interviews revealed denials that staff dug their fingernails into C1’s armpit and/or had no direct knowledge that staff dug their nails into C1’s armpit.

Confidential interviews and records reviewed did not provide a preponderance of evidence to prove or disprove the allegation that staff handled C1 in a rough manner. Therefore, the allegation is unsubstantiated.

An exit interview was conducted, and appeal rights were reviewed with Lerone Jenkins. Due to printer malfunction, a copy of this report, along with the LIC 811, and appeal rights will be emailed to the Facility Administrator. A signed copy of this report will be kept in the Facility file.
SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) -782-4968
LICENSING EVALUATOR NAME: Charmaine LinleyTELEPHONE: 951-202-1850
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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