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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604013
Report Date: 07/26/2023
Date Signed: 07/26/2023 04:26:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
07/18/2023 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20230718144137
FACILITY NAME:CROWNVIEW PSYCHIATRIC INSTITUTE INC.FACILITY NUMBER:
374604013
ADMINISTRATOR:BRITTANY PERKINSFACILITY TYPE:
772
ADDRESS:1110 CAMINO DEL SOL CIRCLETELEPHONE:
(760) 231-1170
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:6CENSUS: 5DATE:
07/26/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Jennifer Vargas, AdministratorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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On 7/26/2023 at about 10:15 AM, Licensing Program Analyst (LPA) Daniel Pena, conducted an unannounced complaint visit to the facility. After introducing and identifying himself, LPA met with Administrator, Jennifer Vargas and discussed the purpose of the visit.

During todays visit, LPA briefly toured the facility, interviewed staff, and obtained copies of facility records. It was alleged that the facility unlawfully evicted Client 1 (C1). Based on record reviews, interviews with outside sources and admission by facility personnel, the facility did not evict C1 in accordance with Title 22, Eviction Procedures. Investigation revealed sufficient evidence that the Preponderance of Evidence standard has been met. Therefore, the allegation is Substantiated.

California code of Regulations, Title 22, Division 6 & Chapter 1 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator,Vargas whose signature below confirms receipt of these rights.

An exit interview was conducted and a copy of Licensee's Rights (LIC 9058 3/22) along with a copy of this report was provided to Administrator, Vargas.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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-20230718144137
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CROWNVIEW PSYCHIATRIC INSTITUTE INC.
FACILITY NUMBER: 374604013
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
08/09/2023
Section Cited
CCR
80068.5(c)
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Eviction Procedures. The notice to quit shall state the reasons for the eviction, with specific facts supporting the reason for the eviction including the date, place, witnesses, if any, and circumstances. This requirement is not met as evidenced by:
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Licensee agrees to contract for vendorized Personal Rights and Eviction Procedures training for all staff. Licensee to submit receipt of contract by 7/28/2023 and wrtiten evidence of completed training by POC date of 8/9/2023.
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Based on interviews and record review the licensee did not issue a lawful eviction notice for 1 out of 4 clients [C1] in care which posed a potential personal rights violation.
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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: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2