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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604208
Report Date: 03/27/2024
Date Signed: 03/27/2024 02:34:12 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
03/20/2023 and conducted by Evaluator Dawn Segura
COMPLAINT CONTROL NUMBER: 08-AS-20230320162533
FACILITY NAME:LIBERTY TRANQUILITYFACILITY NUMBER:
374604208
ADMINISTRATOR:SMITH, DAVIDFACILITY TYPE:
737
ADDRESS:1404 ASH STREETTELEPHONE:
(760) 654-6277
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY:4CENSUS: 4DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Ali Jaouhar, StaffTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Facility staff handled client in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility and met with Ali Jaouhar, Lead Behavioral Support Professional, to whom she disclosed the reason for the visit.

It was reported to Community Care Licensing that S1 entered C1’s room, while C1 was asleep, to administer medications. In an attempt to awaken C1, it was alleged that S1 forcefully removed the blanket and comforter that were covering C1, grabbed C1’s arm and, subsequently, moved C1’s legs to the edge of the bed in a forceful manner in an attempt to pull C1 into a sitting position. Additionally, it was alleged that S1 was speaking to C1 in a raised voice while moving C1.

Community Care Licensing (CCL) has investigated the above-listed complaint allegation. The investigation consisted of a tour of the facility and interviews of facility clients and staff. Interviews conducted during the
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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-20230320162533
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 TRANQUILITY
FACILITY NUMBER: 374604208
VISIT DATE: 03/27/2024
NARRATIVE
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investigation did not yield evidence to corroborate the allegation. Accordingly, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Ali Jaouhar, and copies of this report and Licensee Rights were provided to the staff at the conclusion of the visit. Ali’s signature on this report acknowledges receipt of copies of the report and the rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2