374604298-10-25-2022-08-AS-DPOL-CKQSPS-20221031140336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604298
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:45:16 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
03/24/2021 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20210324145448

FACILITY NAME:	MACKENZIE CARE HOME		FACILITY NUMBER:	374604298
ADMINISTRATOR:	PREECE, RAQUEL		FACILITY TYPE:	735
ADDRESS:	2487 MACKENZIE CREEK R		TELEPHONE:	(760) 460-1129
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91914
CAPACITY:	4	CENSUS: 4	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Raquel Preece		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff physically abused resident
Staff verbally abused resident
Resident sustained injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility by Administrator, Raquel Preece, with whom LPA met and disclosed the reason for the visit. The Department investigated the above listed complaint allegations. The investigation consisted of a tour of the facility, multiple interviews with staff and outside sources, and records review, including medical records and other relevant evidence pertinent to this investigation.

On March 24, 2021, Community Care Licensing (CCL) received a complaint alleging that facility staff physically abused Client #1 (C1), [an LIC 811 Confidential Names List was provided to staff to identify the Client]. On March 23, 2021 the facility self-reported an incident when C1 eloped from the facility indicating they were going to the hospital. Staff were not able to redirect C1 to prevent C1 from leaving the facility.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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-20210324145448

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: MACKENZIE CARE HOME	FACILITY NUMBER: 374604298
	VISIT DATE: 10/25/2022

NARRATIVE

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(Continue from LIC9099)

To ensure C1’s safety, a staff member attempted to follow C1 but lost track of them. Approximately, five minutes after C1 had left the facility, the staff received a phone call from a nearby medical office to let them know C1 was with them. When staff arrived at the medical office, they observed C1 was being escorted inside. An employee from the medical office informed facility staff that they had called local law enforcement. Subsequently, law enforcement called an ambulance to transport C1 to a hospital for examination. C1 reported to law enforcement that their arm hurt because facility staff had physically hit them on their arm. However, a few minutes later, C1 changed their statement indicating they had hurt their arm when they fell down the stairs at the facility.

During an interview, C1 maintained they had hurt their arm when they fell down the stairs but could not recall the date that it happened. C1 was observed with no visible signs of abuse or injuries. C1's chest, face and arms were observed free from any signs of bruising. During the interview, C1 also denied staff hurting them physically or verbally. Review of facility records indicated facility staff reported the elopement incident to C1's Responsible Party, Community Care Licensing and the client’s placement agency as required by Title 22 regulations.

Review of C1’s records including the Appraisal/Needs and Services Plan (LIC625), Consumer Placement Referral Report, Physician’s Report, and other facility records relevant to the investigation indicated C1 had a diagnosis is Mild Intellectual Disability. C1 tended to engage in inappropriate behaviors including multiple elopement attempts, verbal and physical aggression, and self-injurious behaviors. C1 had a documented history of continually contacting 911 to go to the hospital for non-emergency situations.

Interviews with staff and outside sources confirmed that C1 had a history of elopement and calling 911 to be taken to the hospital for no apparent medical need. Records review and interviews with outside sources indicated that C1showed the same pattern of behavior when they were placed in other adult residential facilities. Interviews with outside sources indicated that they never observed staff physically or verbally abusing C1. Facility staff denied the allegation.

Based on interviews with staff and outside sources, and review of pertinent client records and facility records there was insufficient evidence found to support the allegation that facility staff physically abused C1. (Continue on LIC9099C

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20210324145448

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: MACKENZIE CARE HOME	FACILITY NUMBER: 374604298
	VISIT DATE: 10/25/2022

NARRATIVE

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(Continue from LIC9099C)

It was also alleged that facility staff verbally abused C1. This allegation follows the same details as the first allegation of this report and was also based on C1’s inconsistent and contradictory statements during the same incident that occurred on March 23, 2021. Based on interviews with ~~key~~ staff and outside sources, and review of pertinent client records, facility records including incident reports, there was insufficient evidence found to support the allegation that facility staff verbally abused C1.

During the same incident of March 23, 2022, in addition to the first two allegations listed on this report, it was also alleged that C1 sustained an injury while in care, as a result of alleged physical abuse by staff. However, it was later indicated that C1 sustained an injury on their arm when they allegedly fell down the stairs. As stated in the first allegation, C1 was transported to a hospital to be evaluated, and no injuries were assessed. In addition, on April 1, 2021, C1 was observed with no signs of abuse or injuries on their body. Also, during a tour of the facility, the Department inspected the area of the stairs where C1 allegedly fell. The facility stairs were observed to be clean and free from clutter. Specifically, no observable obstacles were on the stairs that would be a safety hazard for clients in care. Interviews with C1, staff, and outside sources and review of medical records and various LIC624s, resulted in insufficient evidence to support the allegation that C1 sustained an injury while in care during this time period.

Based on the results of the investigation, there was insufficient evidence to support any of the three allegations listed in this report. Therefore, these allegations are unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violation occurred.

An exit interview was conducted with Administrator, Preece, to whom a copy of this report, Confidential Names List (LIC 811) and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC9099 (FAS) - (06/04)

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