374604282-2-24-2023-08-AS-JRAE-CPH3SM-20230228173033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604282
Report Date: 02/24/2023
Date Signed: 02/24/2023 02:19:22 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
03/22/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210322090245

FACILITY NAME:	ABIGAIL'S HOMES III		FACILITY NUMBER:	374604282
ADMINISTRATOR:	GONZALEZ, BRENDA ABIGAIL		FACILITY TYPE:	735
ADDRESS:	2505 ARCADIA AVE		TELEPHONE:	(619) 439-7791
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	4	CENSUS: 2	DATE:	02/24/2023
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Mario Moreno, Staff		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff member hit resident resulting in bruising.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint. LPA identified herself, was granted entry, and stated the purpose of the visit to Mario Moreno, Staff. During the investigation, LPA toured the facility, conducted interviews and conducted a records review. It was alleged that staff member hit resident resulting in bruising.

Interviews revealed on or around March. 8, 2021 that staff allegedly slapped Client 1 (C1). Interviews with outside sources revealed (C1) had bruises on arm by elbow but did not know where the bruises came from. Interviews with staff that worked on or around the date of incident, denied allegation of hitting C1. Interviews with staff 1 (S1) revealed that they have been hit by C1 several times but have never hit C1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

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-20210322090245

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: ABIGAIL'S HOMES III	FACILITY NUMBER: 374604282
	VISIT DATE: 02/24/2023

NARRATIVE

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The Individualized Program Plan (IPP), dated: October 31 2021, for C1 indicates that C1 is aggressive towards staff and others. A review of facility records show an incident report that was submitted to the department on March. 19, 2021 regarding bruises on C1. The date of incident is on around March. 08, 2021. Interviews with outside sources did not reveal any evidence regarding staff slapping C1. There is no record of where the bruises came from and interviews with client did not reveal the source. Interviews with S1 revealed C1, their parent, and San Diego Regional Center (SDRC) was on a zoom meeting on March 18, 2021, when C1 revealed being hit by facility staff.

Based on the evidence obtained from the investigation, the above-mentioned allegation is unsubstantiated. An exit interview was conducted with Mario Moreno, Staff A copy of this report and Licensee Appeal Rights (9058 3/22) were provided to the staff at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2023

LIC9099 (FAS) - (06/04)

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