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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604207
Report Date: 12/19/2022
Date Signed: 12/19/2022 02:11:56 PM

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
11/10/2022 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20221110134859
FACILITY NAME:LIBERTY HARMONYFACILITY NUMBER:
374604207
ADMINISTRATOR:MANIPON, CHERIFERFACILITY TYPE:
737
ADDRESS:2915 DUCK POND LANETELEPHONE:
(760) 975-7176
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:4CENSUS: 4DATE:
12/19/2022
UNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Cherifer Manipon, Program Director TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee did not meet staff-client ratio for clients in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted a visit to conclude a complaint investigation. LPA was granted entry into the facility and met with Cherifer Manipon, Program Director, to whom she disclosed the purpose of the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of a review of facility and outside source records.

It was alleged that the licensee did not meet staff-client ratio for clients in care. It was reported that, based upon the needs of the clients in care, on 5/1/2022 and 5/2/2022, the licensee was required to have a minimum of five staff working on each of the AM and PM shifts and a minimum of four staff working on the nocturnal shift. On 6/18/2022, licensee was required to have a minimum of eight staff working on the AM shift. A review of facility and outside source records reflected that on 5/1/2022, from approximately 6:00 AM to 9:00
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
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 3
Control Number 08-AS-20221110134859
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: LIBERTY HARMONY
FACILITY NUMBER: 374604207
VISIT DATE: 12/19/2022
NARRATIVE
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AM, there were four staff working in the facility and on 5/2/2022, from 6:00 AM to 7:00 AM, there were four staff working. On 6/18/2022, from 7:00 AM to 8:00 AM, there were seven staff working. During the identified time frames, the licensee did not have the minimum required number of staff providing client care.

Based upon the foregoing, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited per California Code of Regulations, Title 22, and is noted on the attached LIC9099-D.

An exit interview was conducted with Cherifer Manipon, Program Director, and copies of this report and Licensee/Appeal Rights (LIC9058) were provided to the Program Director at the conclusion of the visit. Cherifer Manipon's signature on this report acknowledges receipt of the report and the rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20221110134859
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: LIBERTY HARMONY
FACILITY NUMBER: 374604207
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/19/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/16/2023
Section Cited
CCR
80065(a)
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Personnel Requirements. Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:
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Program Director offered to provide a completed LIC 500 and written staffing contingency plan for staff call-outs and shortages to Community Care Licensing by the POC due date.
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Based on review of facility records, licensee did not have personnel sufficient in numbers to meet the needs of clients in care. This posed potential safety and personal rights violations to 4 of 4 clients in care.
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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: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3