374604373-8-15-2025-08-AS-RCLK-DL5MA3-20250902092537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604373
Report Date: 08/15/2025
Date Signed: 08/15/2025 01:14:30 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
07/30/2025 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20250730085608

FACILITY NAME:	FLORA'S PLACE		FACILITY NUMBER:	374604373
ADMINISTRATOR:	JACKSON, JEFF		FACILITY TYPE:	735
ADDRESS:	812 DAVID DR.		TELEPHONE:	(619) 746-5009
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	4	CENSUS: 3	DATE:	08/15/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jeff Jackson		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Client sustained an unexplained injury while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Administrator Jeff Jackson and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation, records review, interviews with staff, clients and outside sources.

It was alleged that Client 1 (C1) sustained an unexplained injury at the facility. It was reported that C1 was seen with a bruise on their right bicep, when asked about the bruise C1 stated "it was nothing." Records review revealed C1 had a diagnosis of; autism, mild intellectual disability and OCD. Records review further revealed; C1 may hit themselves. C1 may hit their side legs, punch their own arm or hit the wall when they feel they are in a crowded place, when others contradict C1 or when others go against what C1 wants to do.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

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-20250730085608

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: FLORA'S PLACE	FACILITY NUMBER: 374604373
	VISIT DATE: 08/15/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA interviewed Client 2 (C2) who stated that they really like the facility. C2 stated that the staff treat C2 with respect. C2 stated that they are familiar with C1. C2 stated that they have never witnessed staff mistreat or hit any clients in care. C2 stated that they have never seen any bruises or marks on C1. C2 stated C1 "was good here."

LPA interviewed Client 3 (C3) who stated that they are "good" at the facility. C3 stated that they are familiar with C1. C3 stated that "C1 was good here." C3 stated that C1 had a bruise on their body. C3 stated that they have never witnessed staff being aggressive or hit a client.

Staff 1 (S1) stated the following regarding C1. The first night C1 arrived at the facility they showered and got ready for bed. C1 was walking around the house in a tank top and S1 noticed 2 bruises on their arm. S1 stated that they did not think much of the bruises since C1 was a former client and one of their behaviors was hitting themselves on their arm or stomach randomly. S1 stated that it was obvious the behaviors were still occurring at their responsible party's home.

LPA interviewed C1's Responsible Party (RP). RP stated that C1 has a history of doing a lot of self-harm and self-injuries. RP stated that C1 has obsessive compulsive disorder (OCD) which contributes to the self-harm. RP stated that at one point in time C1 would hit one glute over and over causing a large bruise. RP stated when they ask C1 why they hit themselves C1 states "I'm a dummy, I'm a dummy." RP stated that when C1 is told not to hit themselves C1 hits themselves even more. RP stated that they have advised staff at various facilities and programs to ignore C1 when they are hitting themselves since C1 would just do it even more. RP stated that C1 has a high tolerance for pain which results in C1 developing large, dark bruises. RP stated that C1 lived at the facility for over a year and the facility staff is still "like family" with C1. RP stated that C1 now lives with RP. RP stated that they recently placed C1 at the facility for a short stay (Respite Care) in July 2025 while RP traveled out of the country. RP stated that they do not believe that the bruise found on C1 was caused by facility staff.

LPA interviewed Outside Agency (OA) who stated that they recently assisted in placing C1 at the facility for Respite Care. OA stated that C1's RP requested C1 stay at the facility while RP traveled out of the country. OA stated that they were informed by RP that C1 displays a lot of self injurious behavior. OA stated that it was "not a surprise" when they were informed that C1 was seen with a bruise. OA stated that when RP returned home they advised RP of the incident.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20250730085608

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: FLORA'S PLACE	FACILITY NUMBER: 374604373
	VISIT DATE: 08/15/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA interviewed Administrator (ADM) who stated that they did notice a bruise on C1 on July 26, 2025. ADM stated that they advised RP of the bruise on C1. ADM asked C1 about the bruise and C1 stated they hit themselves. ADM asked C1 not to hit themselves. ADM stated that about a minute later C1 hit themselves again in the same area. ADM stated that this is "normal" behavior for C1, especially when C1 is "stressed out." ADM apologized for not submitting an incident report for the bruise on C1.

On November 16, 2024 the CCL San Diego Regional Office received an incident report indicating that C1 was seen with bruises on their lower abdomen. C1 advised facility staff that C1 was "self harming" all day, due to stress.

The investigation did not reveal any corroborating evidence that facility staff or clients caused the bruise on C1. Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is unsubstantiated.

An exit interview was conducted with Jeff Jackson. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Jeff Jackson whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3