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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604372
Report Date: 01/19/2023
Date Signed: 02/02/2023 04:57:14 PM

Substantiated


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
12/14/2021 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20211214135352
FACILITY NAME:LINO AND AMIE'S BOARD AND CARE INC.FACILITY NUMBER:
374604372
ADMINISTRATOR:DELACRUZ, CATALINO/AMELIAFACILITY TYPE:
735
ADDRESS:11383 SPICA DRIVETELEPHONE:
(858) 254-5041
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 6DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:Licensee, Amelia DelacruzTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Clients are left unsupervised
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegations. LPA met with Licensee, Amelia Delacruz.

During the investigation, a tour of the facility was conducted, records reviewed, and interviews with staff, clients, and outside sources. It was reported clients are being left unsupervised at the casino and being left in the car, while the licensee runs errands at the store. A review of facility records indicated only two out of six clients can leave the facility unassisted. Therefore, the other four clients require supervision. Clients confirmed waiting in the car, while the licensee runs errands in the store. The licensee also confirmed leaving the clients in the car, while at the store. The licensee explained clients are given a choice if they want to remain in the vehicle together or enter the store. The licensee denied leaving the clients unsupervised at the casino and explained there is a staff member that does not gamble that accompanies them. The staff member confirmed they do not gamble and will supervise the clients, while the others gamble. Clients confirmed they are not left unsupervised at the casino. Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California code of Regulations, Title 22, Division 6 & Chapter 1 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report, Licensee Rights (LIC 9058 01/16) and LIC 421IM were provided to Amelia Delacruz whose signature below confirms receipt of these rights. This is an amended version of the original report created on 01/19/23. An immediate civil penatly is being assessed for absence of supervision.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20211214135352
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: LINO AND AMIE'S BOARD AND CARE INC.
FACILITY NUMBER: 374604372
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/19/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/09/2023
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by:
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Licensee stated they will attend training along with staff regarding client supervision and provide proof of training by POC due date. This is an amended version of the original report created on 01/19/23.
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Based on interviews and record the licensee did not provide supervision for four out of six clients by leaving the clients unsupervised in the car. This posed a potential health and safety risk to clients in care.
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An immediate civil penatly was assessed for absence of supervision.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
12/14/2021 and conducted by Evaluator Natasha Persaud
COMPLAINT CONTROL NUMBER: 08-AS-20211214135352

FACILITY NAME:LINO AND AMIE'S BOARD AND CARE INC.FACILITY NUMBER:
374604372
ADMINISTRATOR:DELACRUZ, CATALINO/AMELIAFACILITY TYPE:
735
ADDRESS:11383 SPICA DRIVETELEPHONE:
(858) 254-5041
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 6DATE:
01/19/2023
UNANNOUNCEDTIME BEGAN:
03:41 PM
MET WITH:Licensee, Amelia DelacruzTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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2
3
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5
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8
9
Staff did not treat client with dignity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Natasha Persaud conducted an unannounced visit to conclude the investigation regarding the above mentioned allegations. LPA met with Licensee, Amelia Delacruz.

During the investigation, a tour of the facility was conducted, records reviewed, and interviews with staff, clients, and outside sources. It was reported the staff did not treat Client #1 (C1) with dignity. Investigation revealed an outside source was present at the facility on 12/09/21 when it was alleged the licensee called C1 a crybaby. The outside source did not witness the licensee call C1 a crybaby. Client interviews indicated the licensee treats them with dignity and has not called them a crybaby or any other names. Licensee denied calling C1 a crybaby or any other names. Licensee stated they treat all clients with dignity. Staff interviews also indicated not witnessing the licensee calling the clients names or treating them without dignity.

During the course of the investigation interviews were conducted and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation is deemed unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3