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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604401
Report Date: 06/15/2023
Date Signed: 06/15/2023 07:27:39 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
06/02/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230602082837
FACILITY NAME:CASA DEL MANANA LLCFACILITY NUMBER:
374604401
ADMINISTRATOR:HERNANDEZ, CRISTINAFACILITY TYPE:
735
ADDRESS:1190 5TH AVE., #B3TELEPHONE:
(619) 841-4753
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 4DATE:
06/15/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Cristina HernandezTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff did not treat client with dignity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to deliver findings on the above allegation. LPA was granted entry by Staff, Alejandra Estrada. Staff telephoned the Administrator, Cristina Hernandez. LPA discussed the purpose of the visit with Administrator, Hernandez, who remained on the telephone the duration of the visit.

The Department investigated the above listed complaint allegation. The investigation consisted of interviews with clients and facility staff and outside sources.

On June 2, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff (S1) did not treat client (C1) with dignity, [an LIC 811 Confidential Names List was provided to staff to identify the client and staff].

(Continue at LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
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-20230602082837
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: CASA DEL MANANA LLC
FACILITY NUMBER: 374604401
VISIT DATE: 06/15/2023
NARRATIVE
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(Continued from LIC9099)

It was specifically alleged that on or about May 10, 2023, C1 found a hair in their breakfast burrito and that S1 made offensive and inappropriate comments to C1. According to client and staff interviews, S1 made derogatory statements about C1 when describing the incident in the presence of other clients. Staff and client interviews indicated that on May 29, 2023, C1 also found hair in their food. According to staff and client interviews, there were no problems reported regarding this incident. As a result of the incident that occurred on May 10, 2023, S1 received disciplinary actions and was put on short-term leave. Training on personal rights was also conducted for all staff. In addition, procedures were put into practice for all staff to wear food safety hair nets to prevent loose hair from falling into food while cooking client meals.

We have found there is a preponderance of evidence to prove the alleged violation occurred and is therefore substantiated. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Administrator, Hernandez.

An exit interview was conducted with Administrator, Hernandez and a copy of this report, Deficiency LIC9099D, LIC811 and Licensee's Rights (LIC9058) were provided at the conclusion of the meeting to Staff, Alejandra Estrada.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230602082837
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: CASA DEL MANANA LLC
FACILITY NUMBER: 374604401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/15/2023
Section Cited
CCR
80072(a)(1)
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Personal Rights. To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:
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Plan of Correction was conducted as indicated in the LIC9099 and LPA cleared during the visit. No additional follow-up warranted at this time.
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Interviews revealed that staff S1 did not treat C1 with dignity. This posed a potential personal rights risk to one of (4) clients in care.
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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: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3