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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604001
Report Date: 01/12/2023
Date Signed: 01/12/2023 12:17:00 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
01/09/2023 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20230109190328
FACILITY NAME:CALI SWEETHEARTFACILITY NUMBER:
374604001
ADMINISTRATOR:ARIANA GONZALEZFACILITY TYPE:
735
ADDRESS:1063 WOODHAVEN DRTELEPHONE:
(619) 750-4083
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 1DATE:
01/12/2023
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Sylvia Torres, CaregiverTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Items that pose a danger were accessible to clients in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Sylvia Torres, Caregiver to discuss the purpose of the visit. LPA toured the facility, reviewed records and conducted interviews. It was alleged that items that pose a danger were accessible to clients in care. Interviews with outside sources revealed that on January. 5, 2023 there were some clorox wipes, disinfectanant and also mouthwash that contained alcohol left accessible to clients. Interviews revealed the staff immediately put the items away. Interviews with staff also revealed that they were cleaning around the facility prior to cooking. Once they started cooking they had left the wipes out. The mouthwash was out from the client using it earlier that morning. 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 Sylvia Torres, Caregiver and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
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-20230109190328
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: CALI SWEETHEART
FACILITY NUMBER: 374604001
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/20/2023
Section Cited
CCR
80087(g)
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Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement is not met as evidenced by:
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Cleaning supplies were locked immediately during the visit removing the immediate threat. Administrator stated moving forward they will lock up after each use.
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Based on record review, the licensee did not ensure cleaning supplies were made inaccessbile to 1 out of 1 client.
This poses an immediate health and safety risk to residents in care.
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 Licensee will conduct in-service training on items that could pose a danger/ inaccessbile to residents. POC and documents9Signin sheet/any handouts) due by 01/20/2023.
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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: 01/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2