374604245-6-6-2023-08-AS-DPOL-CT9PFE-20230629111637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604245
Report Date: 06/06/2023
Date Signed: 06/06/2023 05:26:19 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
11/14/2022 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221114101014

FACILITY NAME:	CHLOE'S HOME		FACILITY NUMBER:	374604245
ADMINISTRATOR:	ENGAY, ERWIN		FACILITY TYPE:	735
ADDRESS:	228 CARTER STREET		TELEPHONE:	(619) 995-8874
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	4	CENSUS: 3	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	04:14 PM
MET WITH:	Don Longalong, Administrator		TIME COMPLETED:	04:44 PM

ALLEGATION(S):

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Staff are not providing adequate supervision over resident(s) in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Don Longalong, Administrator, after identifying herself and explaining the reason for the visit.

On November 14, 2022, it was alleged that staff did not provide adequate supervision to client in care, specifically when a client caused property damage to a neighbor’s vehicle. The Department’s investigation consisted of review of facility records, outside source records, and interviews of facility staff and outside sources.

The facility self-reported an incident that occurred on November 10, 2022 involving Client 1 (C1). As C1 was being dropped off from their Day Program, interviews indicted that C1 was upset at not seeing their favorite

[Continued on LIC9099, Page 1 of 2]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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-20221114101014

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: CHLOE'S HOME	FACILITY NUMBER: 374604245
	VISIT DATE: 06/06/2023

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

staff member waiting for them. C1 ran away from the van that dropped them off. C1 ran to the neighbor’s property and attempted to cause property damage to a neighbor’s truck. Administrator was waiting for C1 when they were dropped off and was able to stop C1 from causing damage by placing themselves as a barrier between C1 and the truck. Administrator redirected C1 and was able to successfully disengage C1 from their destructive behavior and go inside the facility. Outside sources and LPA observations indicated that there was no damage to the truck. The van’s driver was with the facility’s other clients while Administrator was with C1. An outside source was able to confirm that C1 had been visibly agitated and upset that day.

Review of facility records indicated that facility is considered by San Diego Regional Center to be a Level 4 home, the highest level, which means the facility had clients with severely disruptive or self-injurious behavior. The facility had nine (9) staff working at the facility in November 2022. Four (4) staff worked in the morning, two (2) worked the afternoon shift, and two (2) worked the overnight shift. The facility had a census of four (4) in November 2022. Review of unusual incidents submitted by the facility indicated that C1 has engaged in property destruction before.

Preplacement records for C1 indicated that client is more likely to engage in property destruction during an emotional outburst. Facility records also indicated that C1 frequently engages in property destruction and was considered a known behavior of the client. Outside source interviews and records indicated that C1 had successfully caused property damage to a different truck in March 2023 at their day program. C1 paid for the damages they caused at that time.

Based on the evidence obtained during the complaint investigation, the allegation that staff did not provide adequate supervision to client in care is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

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