374604307-2-27-2024-08-AS-JLOT-D2W7D2-20240228203333

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604307
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:06:17 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2020 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20201015161240

FACILITY NAME:	WALK OF LIFE, ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	374604307
ADMINISTRATOR:	LEWIS-BARRETO, ANNABELLE		FACILITY TYPE:	735
ADDRESS:	168 EVVIA COURT		TELEPHONE:	(707) 439-1816
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	6	CENSUS: 6	DATE:	02/27/2024
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Licensee, Annabelle Barretto		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff improperly restrained client

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA was greeted by Caregiver, Maria Rivera. LPA spoke and delivered findings via telephone with Licensee, Annabelle Barretto.

The Department investigated the above-listed complaint allegation. The investigation consisted of observations, a review of relevant records, and interviews with facility staff, and outside sources.

On October 15, 2020, Community Care Licensing (CCL) received a complaint alleging that staff (S1) had improperly restrained client (C1). It was specifically alleged that on October 9, 2020, S1 restrained and dragged C1 down the hallway. On October 21, 2020, during a tour of the facility via FaceTime, clients in care were observed to be alert with no visible signs of injuries.

(Continue at LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20201015161240

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: WALK OF LIFE, ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 374604307
	VISIT DATE: 02/27/2024

NARRATIVE

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(Continue from LIC9099)

During staff interviews, it was consistently stated that on October 9, 2020, C1 became upset when staff did not allow them to wear toileting products that belonged to another client. Despite S1’s effort to de-escalate the situation between the two clients, C1 became aggressive towards S1 and the other client. Per multiple interviews with staff, it was indicated that C1 had a history of aggressive behaviors toward staff and clients. In addition, a detailed review of C1’s records indicated that C1 had a history of self-injurious (SIB) behaviors and would often hurt themselves during behavior outbreaks. In addition, during interviews with C1, staff, and outside sources it was evident that C1 tended to misrepresent and/or embellish the facts of incidents. According to outside sources, this was not the first time C1 had reported similar incidents. Facility management indicated that all staff including S1 had received proper training on de-escalation intervention procedures to meet the specific client's needs. Subsequent interviews with staff confirmed that they had received the training and were knowledgeable about how to handle clients’ aggressive behaviors. No additional details of any other incidents of staff improperly mistreating clients were disclosed during the investigation.

The Department has investigated the above-mentioned allegation and based on interviews with staff, clients, outside sources, and records review, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated.

An exit interview was conducted with Licensee, Barretto (via telephone). Caregiver, Maria Rivera signed the report on behalf of Licensee Barretto, to whom a copy of this report, and the Licensee Appeal Rights (LIC9058 01/16), were provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

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