374604348-2-7-2023-18-AS-JESL-CTA5LS-20230629200335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604348
Report Date: 02/07/2023
Date Signed: 02/07/2023 01:12:09 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/20/2022 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20220620113009

FACILITY NAME:	UTAH FACILITY CARE		FACILITY NUMBER:	374604348
ADMINISTRATOR:	ROKSANDIC, RADA		FACILITY TYPE:	735
ADDRESS:	662 UTAH WAY		TELEPHONE:	(442) 777-2024
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	6	CENSUS: 5	DATE:	02/07/2023
		UNANNOUNCED	TIME BEGAN:	12:39 PM
MET WITH:	Stefan Okljesa, Caregiver		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff threw water in residents face.
Staff restrained residents.
Staff harass residents.
Staff wouldn't allow resident to go to day program.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegations listed above. During the visit LPA met Caregiver, Stefan Okljesa and explained the purpose of the visit. During the investigation LPA interviewed Staff, interviewed residents, interviewed MDH Network Day Program Community Supervisor, interviewed Elite Academy School Principal, Interviewed San Diego Inland Regional Center, and reviewed facility file.
Regarding the Allegation “Staff threw water in residents face”. LPA interviewed five residents. Three out of five residents denied staff threw water on residents’ face. LPA interviewed staff who denied staff threw water on resident’s face. LPA interviewed San Diego IRC Service Coordinator who stated for the facility, IRC haven’t received any report or complaint from resident of staff throwing water in residents face. LPA reviewed facility file and found no record of the alleged incident.
Regarding the allegation “Staff restrained residents”. It was alleged staff restrained resident #3 on the floor. LPA interviewed residents. Three out of five residents interviewed denied staff restrains resident on the floor. LPA interviewed staff who denied restraining resident on the floor. LPA interviewed San Diego IRC Service Coordinator who stated for the facility, IRC haven’t received any report complaint from resident of staff restraining residents. LPA reviewed facility file and found no record of the alleged incident.

Continue on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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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Control Number 18-AS-20220620113009

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: UTAH FACILITY CARE	FACILITY NUMBER: 374604348
	VISIT DATE: 02/07/2023

NARRATIVE

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Continued from LIC9099

Regarding the allegation “Staff harass residents”. It was alleged staff harass resident #4 with the intent of eliciting maladaptive behaviors and aggression. LPA interviewed residents. Two out of five residents interviewed denied staff harasses resident. LPA interviewed staff who denied harassing resident.

Regarding the allegation “Staff wouldn't allow resident to go to day program”. It was alleged staff didn’t allow Resident #3 to go to a day program. LPA interviewed residents who denied staff wouldn’t allow residents to attend day program. During residents’ interview, it was acknowledged one out of five residents attends day program and another resident attends school. During LPA’s interviewed with resident #3 it was acknowledged resident attend’s Elite Academy. Resident denied staff refused resident to attend school. LPA interviewed Elite Academy school principle who confirmed resident #3 attends school regularly and haven’t had problem with attendance. LPA interviewed Resident #2 who acknowledged attends MDH Network Day Program. LPA interviewed MDH Network Day Program Community Supervisor who confirmed Resident #2 attends day program regularly and haven’t heard anything about staff preventing Resident #2 from attending day Program.

Based on LPA’s interviews there is not enough evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Stefan Okljesa.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

LIC9099 (FAS) - (06/04)

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