374604282-5-19-2023-08-AS-IESA-CSDPPJ-20230601112934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604282
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:00:58 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
02/08/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210208122404

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:	05/19/2023
		UNANNOUNCED	TIME BEGAN:	02:40 PM
MET WITH:	Mario Moreno. Caregiver		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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9

Physical abuse to resident by staff member resulting in injury
Facility staff chemically-restrained client.
Facility is interfering with communication between client and conservator.

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 physical abuse to resident by staff member resulted in injury. Interviews revealed on or around January. 30 2021 that staff allegedly hit Client 1 (C1). Interviews with staff that worked on or around the date of the incident, denied the allegation of hitting C1. Interviews with staff 1 (S1) revealed that they have been hit by C1 on several occassions by C1 but they have never hit C1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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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