374604331-8-22-2025-08-AS-APAO-DL25PA-20250829200736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604331
Report Date: 08/22/2025
Date Signed: 08/22/2025 12:00:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
11/05/2024 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20241105090140

FACILITY NAME:	MARANATHA DAY PROGRAM		FACILITY NUMBER:	374604331
ADMINISTRATOR:	GUIBERT, NICOLE		FACILITY TYPE:	775
ADDRESS:	1112 BROADWAY, #103		TELEPHONE:	(619) 760-3322
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	45	CENSUS: 36	DATE:	08/22/2025
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Nicole Guibert, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Client sustained unexplained injury while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. LPA was allowed entry by the Administrator.
LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Administrator.

The Department received a complaint that alleged that: client sustained an unexplained injury while in care. The investigation consisted of a tour of the facility, interviews, review of records. On November 1, 2024, R1 became ill and had not returned to their day program since that date. The Power of Attorney informed the day program staff leader that R1 was hospitalized due to low oxygen levels. While hospitalized, R1 experienced a stroke. The anticipated release date from the hospital was not currently known at the initial investigation process.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

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-20241105090140

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MARANATHA DAY PROGRAM	FACILITY NUMBER: 374604331
	VISIT DATE: 08/22/2025

NARRATIVE

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S1 reported that they receive incident reports for all residents, including falls, injuries, or other significant events, and no fall or injury reports were received for R1. Daily morning inspections are conducted for each resident to assess their well-being. During these inspections, no bruises or signs of injury were observed on any residents, including R1.

R1 is ambulatory with a diagnosis that included mild intellectual disability, Down syndrome, and hypothyroidism. R1 was conserved and assigned a Probate Court Investigator on September 28, 2023. The next Individual Program Plan (IPP) meeting is scheduled for December 31, 2025. Observed behaviors include emotional outbursts, physical aggression, and non-cooperation, dropping to the floor to reduce episodes to zero per month.

On August 22, 2025, there were no visible bruises were observed on R1 during the investigation. Residents R2 and R3 confirmed that they have not seen any staff act aggressively toward clients or themselves or have bruises. Staff S3, S4, and S5 confirmed adherence to protocols for checking and documenting bruises and reported no incidents of staff aggression toward clients or bruises for R1. R1 returned to the day program on November 18, 2024.

The investigation concluded that the allegation was unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with the Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025

LIC9099 (FAS) - (06/04)

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