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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604148
Report Date: 02/24/2023
Date Signed: 02/24/2023 01:56:30 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
05/12/2022 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20220512162223
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:
02/24/2023
UNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Fabian Gonzalez, StaffTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Neglect/Lack of supervision resulted in client on client verbal altercation.
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 Fabian Gonzalez, Staff 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 neglect/Lack of supervision resulted in client on client verbal altercation. Interviews revealed on 5/12/2022 staff called Client 1 (C1) day program in the morning sharing that client may be upset over a situation that occurred at the house the evening before. Interviews revealed that C1was up late until 1am talking on the phone and C1 and their roommate exchanged words resulting in C1 roomate not being able to sleep. Interviews revealed that C1 was at program and was visbily upset. Interviews revealed that C1 was so upset that PERT was called and they evaluated the client.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
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-20220512162223
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: 02/24/2023
NARRATIVE
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According to interviews PERT did not take C1 out of program that day and they returned to the facility later that day. There was no time that the clients were not supervised and interviews revealed that the two clients exchanged words but it was nothing of concern that they heard.

Interviews with staff stated the two clients shared a room and that the two clients usually get along very well. Interviews revealed the house administrator did not hear C1 say say anything out of the ordinary to the client.

Based on the evidence obtained from interviews, 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: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2