374604207-12-18-2023-08-AS-LTEZ-CYXR2Y-20231228113906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604207
Report Date: 12/18/2023
Date Signed: 12/18/2023 01:15:48 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
10/11/2023 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20231011171829

FACILITY NAME:	LIBERTY HARMONY		FACILITY NUMBER:	374604207
ADMINISTRATOR:	MANIPON, CHERIFER		FACILITY TYPE:	737
ADDRESS:	2915 DUCK POND LANE		TELEPHONE:	(760) 975-7176
CITY:	RAMONA	STATE: CA	ZIP CODE:	92065
CAPACITY:	4	CENSUS: 4	DATE:	12/18/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Cruz Mora, Assistant Program Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff forced client in care to stay in their bedroom.

Staff denied client in care water when requested.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to conclude an investigation into the above-listed complaint allegations. LPA was granted entry into the facility by Destiny Westney, Lead BSP, and met with Cruz Mora, who arrived a short time later and to whom LPA again disclosed the purpose of the visit.

Community Care Licensing (CCL) has investigated the above-listed allegations. The investigation consisted of a tour of the facility, interviews of facility staff, and review of facility records.

It was alleged that during a NOC shift, Client 1 (C1) was forced to stay in their bedroom when attempting to go into the living area of the home. It was reported that staff who worked during the NOC shift forced C1 to remain in their bedroom. Interviews conducted during the investigation yielded that when C1 gets up during the night, staff try to convince C1 to remain in or return to their bedroom, as staff have observed that C1 is drowsy and more inclined to engage in behavioral episodes on days when C1 has not had enough sleep the

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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-20231011171829

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: 12/18/2023

NARRATIVE

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previous night. Evidence also reflected that C1 has been allowed to sleep on the sofa in the living area when they have expressed a desire to not return to their bedroom and was allowed to do so during the early morning hours of the shift in question. The investigation did not yield evidence to conclude that C1 had been forced to stay in their bedroom during the night.

The second allegation is that staff denied C1 water when it was requested in the early morning hours. It was reported that C1 repeatedly requested water, staff refused to give water and blocked their access to water, indicating that C1 had to wait until 6:00 AM when staff on the morning shift arrived. A review of C1’s Individual Behavior Support Plan reflects that a goal of C1’s is to work toward independence in getting their own water. Interviews indicated that staff are aware of C1’s goal, and the staff work to assist C1 in achieving the goal by encouraging independence in obtaining water, rather than obtaining water for C1 each time it is requested. The investigation did not yield evidence to conclude that C1 requested water and was denied or that staff physically blocked C1’s access to water.
Based upon the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Cruz Mora, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Cruz Mora's signature below serves as acknowledgment of receipt of copies of the report and rights.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC9099 (FAS) - (06/04)

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