374604422-3-4-2022-08-AS-DPOL-CDY2C8-20220429171618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604422
Report Date: 03/03/2022
Date Signed: 03/04/2022 08:50:48 AM

Unfounded

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
02/24/2022 and conducted by Evaluator Liliana Silveira

COMPLAINT CONTROL NUMBER: 08-AS-20220224172508

FACILITY NAME:	LA JOLLA CASA PACIFICA		FACILITY NUMBER:	374604422
ADMINISTRATOR:	FERNANDEZ, JENNIFER		FACILITY TYPE:	740
ADDRESS:	5468 PACIFICA DR		TELEPHONE:	(858) 775-6935
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	6	CENSUS: 5	DATE:	03/03/2022
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	House Manager Violet German		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility not taking measures to prevent COVID-19.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to open a complaint investigation regarding the above mentioned allegations. LPA identified themselves, stated the purpose of the visit and was granted entry by House Manager Violet German.

During this visit and based on a review of records, it was determined that this Complaint was assigned to the incorrect facility. Therefore, the allegation was determined to be unfounded, meaning, it is false, could not have happened, and/or is without a reasonable basis. The Complaint is closed without investigation.

An exit interview was conducted, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Administrator Jennfer Fernandez via email. An electronic email receipt confirms the documents were received.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2022

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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