374604412-3-5-2024-08-AS-LTEZ-D3PTEA-20240325143935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604412
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:42:39 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, 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
02/26/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240226143240

FACILITY NAME:	COOLWATER ADULT SERVICES 2		FACILITY NUMBER:	374604412
ADMINISTRATOR:	MADUNTA, MAXWELL		FACILITY TYPE:	735
ADDRESS:	141 COOLWATER DRIVE		TELEPHONE:	(619) 888-4322
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	4	CENSUS: 4	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Administrator, Heba Castro		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff made inappropriate comments towards client

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud conducted a complaint investigation regarding the above-mentioned allegation. LPA was greeted and allowed entry into the facility by Staff, Gerell Baxter. Administrator Assistant, Rasheed Casper, Administrator, Heba Castro arrived during the visit.

During the investigation, LPA toured the facility, reviewed records, and interviewed staff, clients, and outside sources. It was alleged that staff made inappropriate comments towards Client #1 (C1). It was reported C1 was saying out loud and repeating “if you keep lying, you’re going to hell.” C1’s Physician’s Report dated 11/20/23 indicated they are able to follow instructions, able to communicate, and able to care for all their personal needs, along with reminders and cues. C1’s Individual Program Plan (IPP) dated 08/10/22 indicated C1 can converse well with others and will repeat questions about topics important to them. The IPP also reflected C1 was very close to their provider and other staff at their living facility. Staff interviews revealed they have not made inappropriate comments towards any clients. Staff also stated C1 repeats things they hear and uses them as a reminder for themselves. Continued on an LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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-20240226143240

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: COOLWATER ADULT SERVICES 2	FACILITY NUMBER: 374604412
	VISIT DATE: 03/05/2024

NARRATIVE

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Staff provided an example to reflect when C1 says “if you lie, you’re going to hell” is a coping mechanism that helps C1 not to lie. C1 repeats and uses the statement as a reminder not to lie. Staff confirmed C1 does not lie but may stretch the truth when it comes to minor things but is accurate in their statements. Outside source interviews confirmed the interaction with staff and clients are good. Client interviews revealed they are treated well by staff and there have been no inappropriate comments made. C1’s interview confirmed they are being treated well by staff and no inappropriate comments have been made. C1 was able to explain they learned the phrase about lying from a religious family member. C1 was unable to explain what heaven or hell meant.

Based on interviews and record review, investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Heba Castro whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Client #1]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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