<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604207
Report Date: 07/05/2023
Date Signed: 07/05/2023 12:44:55 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
06/26/2023 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20230626131332
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:
07/05/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Morgan Davis, Quality Assurance ManagerTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not meet staff-client ratio for clients in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Dawn Segura conducted a visit to commence a complaint investigation. LPA was granted entry into the facility and met with Cruz Mora, Lead BSP, to whom she disclosed the purpose of the visit. Morgan Davis, Quality Assurance Manager, arrived a short time later.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. Today’s visit and the investigation consisted of a tour of the facility, review of facility records, and interview of facility staff.

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, while in the home, the licensee was required to have a minimum of seven staff working on each of the AM and PM shifts and a minimum of five staff working on the nocturnal shift. A review of facility records reflects that on 1/8/2023, from approximately 6:00 AM to 8:00 AM
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
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 3
Control Number 08-AS-20230626131332
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: 07/05/2023
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
and 10:00 AM to 12:00 PM, there were 6 staff working in the facility; on 1/9/2023, from 11:00 PM to 12:00 AM, there were 4 staff working; on 1/10/2023, from 12:00 AM to 5:00 AM and 10:00 PM to 12:00 AM, there were 4 staff working; on 1/11/2023, from 12:00 AM to 5:00 AM, there were 4 staff working; on 1/13/2023, from 7:00 PM to 10:00 PM, there were 6 staff working and 11:00 PM to 12:00 AM, there were 4 staff working; and on 1/14/2023, from 12:00 AM to 5:00 AM and 10:00 PM to 12:00 AM, there were 4 staff working. During the identified timeframes, 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. A civil penalty is being assessed, as the deficiency is a repeat violation within a 12-month period of time.

An exit interview was conducted with Morgan Davis, and copies of this report and Licensee/Appeal Rights (LIC9058) were provided to the Quality Assurance Manager at the conclusion of the visit. Her 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: 07/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230626131332
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: 07/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2023
Section Cited
CCR
80065(a)
1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
Licensee has engaged the services of a temporary agency to provide additional staffing.
Licensee's recruiters have been attending job fairs and offering sign-on bonuses to recruit new staff.
8
9
10
11
12
13
14
Based on review of facility records, licensee did not have personnel sufficient in numbers to meet the needs of clients in care. This posed a potential safety risk and personal rights violation to 4 of 4 clients in care.
8
9
10
11
12
13
14
A civil penalty was assessed for a repeat violation within a 12-month period.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 07/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3