374604120-5-30-2023-08-AS-LTEZ-CSCVP8-20230531163619

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604120
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:15:36 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
03/23/2023 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20230323114020

FACILITY NAME:	HUMMINGBIRD HEALING HOUSE		FACILITY NUMBER:	374604120
ADMINISTRATOR:	TATUNAY, NICOLE		FACILITY TYPE:	772
ADDRESS:	5550 UNIVERSITY AVE STE B		TELEPHONE:	(619) 481-6790
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92105
CAPACITY:	15	CENSUS: 15	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Mea Busch, Service Coordinator		TIME COMPLETED:	02:22 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet client's needs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA introduced herself, was granted entry into the facility, and met with Mea Busch, Service Coordinator, to whom LPA disclosed the reason for the visit.

It was alleged that staff did not meet client’s needs. It was reported to Community Care Licensing (CCL) that facility staff do not meet Client 1’s (C1) basic needs by refusing to take C1 to the store to buy food and not allowing C1 to go on outings with C1’s peers. The investigation consisted of a tour of the facility, review of facility records, interviews of facility staff, clients, including C1.

During the investigation, LPA discovered that the facility’s program is designed for clients to progress through the program in phases. When clients enter the facility, clients start at phase 1, during which a client goes out to stores and other community settings with staff. Once a client progresses to phase 2, the client goes out with a peer, and progression to phase 3 allows a client to go out alone, for designated periods of time, to

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

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 4

Control Number 08-AS-20230323114020

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: HUMMINGBIRD HEALING HOUSE	FACILITY NUMBER: 374604120
	VISIT DATE: 05/30/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

acclimate to a return to the community. In order for a client to progress to the successive phase, the client must demonstrate success in the current phase.

Evidence collected during the investigation yielded that C1 is not able to navigate in the community without assistance and just recently satisfactorily fulfilled most benchmarks to progress beyond phase 1, which resulted in C1 needing staff accompaniment when away from the facility. It was also discovered during the investigation that clients can put in requests 48 hours in advance to have staff accompany them out in the community. Provided that staffing is sufficient to accommodate the requests, clients will be accompanied. LPA was informed that C1 has been offered alternative means, such as online shopping or emergency runs, to obtain desired items, if C1 has a basic or emergency need. Additionally, LPA was informed that clients are free to purchase and prepare food items of their choice, if they desire, however, clients are provided 3 meals per day, and the facility has toiletries available to provide, if a client chooses not to purchase toiletries of their own.

Considering the foregoing, based upon a lack of evidence to corroborate the allegation, the allegation is unsubstantiated. This finding means that there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Mea Busch, Service Coordinator, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Service Coordinator at the conclusion of the visit. Her signature below serves as acknowledgment of receipt of copies of the report and rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4