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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603968
Report Date: 08/25/2023
Date Signed: 08/25/2023 09:42:33 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL SC/RES, 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
05/18/2023 and conducted by Evaluator LUCERO JAUREGUI
PUBLIC
COMPLAINT CONTROL NUMBER: 08-CR-20230518165136
FACILITY NAME:A.B. JESSIE POLINSKY CHILDREN'S CENTERFACILITY NUMBER:
374603968
ADMINISTRATOR:ROSAS, ELIZABETHFACILITY TYPE:
721
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:204CENSUS: 32DATE:
08/25/2023
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Norma RinconTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff does not treat minor with dignity and respect.
INVESTIGATION FINDINGS:
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On August 25, 2023 at 9:18 AM, Licensing Program Analysts (LPA's) Lucero Jauregui and Jacob Salem arrived unannounced at the facility and met with Norma Rincon to discuss the investigative finding for the allegation noted above. LPA Gloria Meza-Gonzalez conducted an inspection of the facility on 05/22/2023 at 12:00 pm and no deficiencies were observed. LPA Linley interviewed two clients (C1-2), six staff (S1-6), and one County Social Worker (CSW), and was unable to interview one client (C3), despite multiple attempts to contact them, and one client (C4) declined to be interviewed. LPA Linley reviewed the following documents during the investigation: Virtual Assessment Team (VAT) Screening Form, Child History Report, Dietary Plan, Medical Discharge Summary, and Special Incident Report.

On 05/18/2023, Community Care Licensing (CCL) received an allegation that staff does not treat C1 with dignity and respect.

CONTINUED...
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Ann Valenzuela
LICENSING EVALUATOR NAME: LUCERO JAUREGUI
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
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-20230518165136
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL SC/RES, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: A.B. JESSIE POLINSKY CHILDREN'S CENTER
FACILITY NUMBER: 374603968
VISIT DATE: 08/25/2023
NARRATIVE
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It was reported that staff made negative comments about C1’s weight, hygiene, and hair. Confidential interviews revealed conflicting statements that staff made the comments about C1, while other interviews reported that the other clients made the comments about C1. Thus, confidential interviews did not corroborate the allegation with a preponderance of evidence.

Based on confidential interviews and records reviewed the allegation that the staff does not treat C1 with dignity and respect, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time.

An exit interview was conducted, a copy of this report, LIC 811 (confidential names dated 8/25/23) along with appeal rights were provided to Norma Rincon. A copy of this report will be placed in the facility file.
SUPERVISORS NAME: Ann Valenzuela
LICENSING EVALUATOR NAME: LUCERO JAUREGUI
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2