374604392-7-25-2024-08-AS-JLOT-D7Q4DW-20240731190127

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604392
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:09:26 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
06/29/2021 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20210629111140

FACILITY NAME:	VILLALOBOS ARF #3		FACILITY NUMBER:	374604392
ADMINISTRATOR:	VILLALOBOS, ROGER		FACILITY TYPE:	735
ADDRESS:	875 MISTY MEADOW CT.		TELEPHONE:	(619) 778-8469
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	4	CENSUS: 3	DATE:	07/25/2024
		UNANNOUNCED	TIME BEGAN:	01:09 PM
MET WITH:	Roger Villalobos		TIME COMPLETED:	02:16 PM

ALLEGATION(S):

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Client sustained unexplained bruising.
Licensee did not ensure food was of sufficient quantity
Staff yelled at clients
Facility was not maintained in clean condition

INVESTIGATION FINDINGS:

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

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

It was reported to CCL that Client 1 (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the client) sustained unexplained bruising: LPA interviewed Administrator who stated that C1 was obese and would often "bulldoze" themselves onto staff and other clients. C1 would often fall on the ground resulting in bruises. Interview with outside agency revealed no history of C1 having any unexplained bruises. Interviews and incident reports revealed that observed bruising on C1 was consistent with known medical conditions or accidental causes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

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-20210629111140

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: VILLALOBOS ARF #3	FACILITY NUMBER: 374604392
	VISIT DATE: 07/25/2024

NARRATIVE

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It was alleged that Licensee did not ensure food was of sufficient quantity: LPA and outside agency direct observations revealed that meal portions provided to residents met or exceeded nutritional requirements as per regulatory standards. There was no evidence suggesting systematic deficiencies in the provision of food.

It was alleged that Staff 1 (S1) yelled at clients: Interviews with client and outside agency did not corroborate allegations of staff yelling at clients. Testimonies uniformly indicated respectful interactions between staff and residents, with no substantiated incidents of verbal abuse or mistreatment. LPA interviewed Client 2 (C2) who stated that S1 was always nice with C2. C2 stated that they would talk about C2's issues. C2 stated that S1 never yelled at C2.

It was alleged that the facility was not maintained in clean condition: LPA on-site inspections as well as outside agency inspections revealed that the facility was consistently maintained in a clean and sanitary condition. There were no observed lapses in cleanliness that would substantiate the allegation.

Interview with outside agency (OA) revealed OA has never seen the facility dirty or in disrepair, on the contrary OA has always seen the facility clean and in good condition. OA stated that they have never observed the facility lacking food for clients or having an insufficient amount of food for the clients in care. OA stated that they have never witnessed or heard of any clients having any unexplained bruises or injuries. OA further stated that they have overheard facility staff speaking to clients in a firm manner, but never in a verbally abusive or aggressive manner.

LPA interviewed Administrator who stated that the facility staff do not curse or verbally abuse any clients. Administrator stated that the clients have the option of making their own meals or eating the food that the facility staff prepares. Administrator stated that staff never deny or withhold food from any clients and their is always a sufficient amount of food in the facility.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

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

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

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