374604344-4-2-2025-08-AS-SJAB-DFMQ3D-20250411114833

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604344
Report Date: 04/02/2025
Date Signed: 04/02/2025 07:04:08 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
03/25/2025 and conducted by Evaluator Amy Rodgers

COMPLAINT CONTROL NUMBER: 08-AS-20250325163655

FACILITY NAME:	JIMENEZ HOMES ARF LLC		FACILITY NUMBER:	374604344
ADMINISTRATOR:	JIMENEZ, ERICKA D.		FACILITY TYPE:	735
ADDRESS:	1707 SKYLINE DRIVE		TELEPHONE:	(619) 987-2558
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY:	4	CENSUS: 4	DATE:	04/02/2025
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Licensee Ericka Jimenez		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff hit resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Rodgers made an unannounced visit to open an investigation on the above-mentioned allegation. LPA identified herself and disclosed the purpose of her visit with Licensee/Administrator Erika Jimenez.

On March 25th, 2025 , Community Care Licensing (CCL) received a complaint alleging Staff 1 (S1) hit Client 1 (C1) and C1's friends. More specifically, C1 reported, during the release from a hospital stay, that on unspecified days they were hit by Staff member #1(S1) and also reported that S1 hit their friends. During the investigation today, LPA Rodgers made observations, conducted interviews and reviewed facility records. [See LIC811 Confidential Name List for identification of select person identifiers used in this report].

Review of physicians report (dated 5/10/2024) reveal C1 has a diagnosis with Seizure Disorder and Mental retardation. Individual Service/Behavior intervention plan (dated 1/30/2025) indicates a history of physical aggression, emotional outbursts, property abuse, and elopement. Interviews with outside sources and staff indicate that C1 has a history of making false accusations when asked to engage in non-preferred activity.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

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-20250325163655

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: JIMENEZ HOMES ARF LLC	FACILITY NUMBER: 374604344
	VISIT DATE: 04/02/2025

NARRATIVE

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(Continued from 9099)

Interview with outside source confirms during hospital stay from March 14, 2025, to March 26th, 2025, C1 never mentioned to any hospital staff that he had been hit by any facility staff, and they also confirm the nursing staff did not observe any bruising on C1 body during his hospital stay.

Additionally, interviews with staff and outside sources confirm C1 has a history of making false allegations and attention-seeking behaviors. Interviews with staff and outside sources also confirm they have not witnessed, or had anyone report to them, any issues with staff at the facility that would include abuse of clients. Further, Interviews with other staff at the facility denied ever witnessing Staff #1 hitting any clients. Interview with C1 describe a non-existent staff member and C1 further describes a non-existent name of a staff member that allegedly hit and him friends.

C1 was admitted to the facility in January 2025 and continues to struggle with boundaries, structure, and attention-seeking behavior that includes visits to the hospital. The evidence indicates that C1 was engaging in a non-preferred activity, which led to C1 making a false accusation. Records and interviews revealed that the incident was implausible due to specific details provided by C1 being proven untrue, and interview evidence that the staff member in question is not employed at the facility.

Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Licensee/ Administrator Jimenez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2025

LIC9099 (FAS) - (06/04)

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