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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604148
Report Date: 12/14/2022
Date Signed: 12/14/2022 04:42:33 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
10/07/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20221007131704
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: 1DATE:
12/14/2022
UNANNOUNCEDTIME BEGAN:
11:25 PM
MET WITH:Raquel Garcia, AdministratorTIME COMPLETED:
11:40 PM
ALLEGATION(S):
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Staff on client altercation resulted in injury.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Raquel Garcia, Administrator to discuss the purpose of the visit. LPA’s visit consisted of delivering findings on the above-mentioned allegation.

LPA conducted a physical inspection of the facility, collected relevant records, and conducted interviews with clients, facility staff, and outside sources. It was alleged that staff on client altercation resulted in injury. Interviews revealed Client 1 (C1) was upset and tried to fight staff and the other client. C1 was up pacing back and forth and punched staff 1 (S1) in the face. S1 covered their face to block the punch.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
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-20221007131704
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
VISIT DATE: 12/14/2022
NARRATIVE
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 Interviews revealed that after C1 punched S1 then went around the facility and was hitting walls and kicking the bedroom doors. C1 damaged one of the bedroom doors prior to being taken to the hospital. Interviews revealed the sheriffs were called and observed C1 after S1 explained to them what happened C1 was taken to the hospital. Interviews with S1 revealed S1 denying the allegation of hitting C1 or having an altercation with C1. According to C1s Individual Program Plan (IPP) it states that when C1 gets frustrated, that they quickly becomes physically aggressive towards others. Their aggressive behaviors include punching, kicking, biting, and throwing items onto the floor. C1 also has history of causing minor injuries to others including staff members. C1 can also express their frustrations by
screaming and using foul language. It is reported that their behaviors have overall decreased but C1 continues to need the structure implemented at home and during activities of day program.

Based on the evidence obtained from interviews, records review, the complaint allegation is unsubstantiated.

An exit interview was conducted with Raquel Garcia and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2