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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604148
Report Date: 10/04/2021
Date Signed: 10/28/2021 09:21:13 AM

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
09/28/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210928160959
FACILITY NAME:ABIGAIL'S HOMES IIFACILITY NUMBER:
374604148
ADMINISTRATOR:GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:8738 VALENCIA STTELEPHONE:
(619) 315-7407
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 2DATE:
10/04/2021
UNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Kyla Hall, Caregiver TIME COMPLETED:
11:35 AM
ALLEGATION(S):
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Facility has spolied milk.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA identified herself, was granted entry, and stated the purpose of the visit to Kyla Hall, Caregiver. During the visit, LPA toured the facility and conducted interviews. LPA observed milk in the refrigerator dated October 2, 2021. The milk did have a distinct smell as though it was old and expiring. Interviews revealed that staff go grocery shopping once a week on Monday's and purchase what they need. The staff that goes grocery shopping buys groceries for all of the houses/facilities. Based on LPA Holmes observation, the above allegation is determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted with caregiver Kyla Hall. A copy of this report, the LIC 9099D, and Licensee Appeal Rights (9058 01/16) were emailed to Adminsitrator after the conclusion of the visit, LPA Holmes requested an electronic message reply to confirm receipt of these documents.
This is an amended report from 10/04/2021
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 08-AS-20210928160959
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: ABIGAIL'S HOMES II
FACILITY NUMBER: 374604148
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2021
Section Cited
CCR
80076(a)(1)
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In facilities providing meals to clients, the following shall apply:
All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requiement is not met as evidenced by:
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Staff removed sour milk and poured it down the sink. Licensee will check milk daily to make sure it is not spoiled. Licensee will also buy a smaller jugs since there is only 2 clients and they dont drink milk daily. Licensee will provide LPA with reciept by POC of 10/05/2021
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On 10/04/2021 upon LPA observation, the milk in the refrigerator dated October 2, 2021 had a distinct smell as though it was old and expiring for 2 out of 2 clients. This poses a potential safety risk to clients in care.
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This is an amended report from 10/04/2021
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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: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
LIC9099 (FAS) - (06/04)
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