374604456-7-17-2023-08-AS-SJAB-CU2SH5-20230724135258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604456
Report Date: 07/17/2023
Date Signed: 07/17/2023 12:37:39 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
06/21/2023 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20230621104010

FACILITY NAME:	SAY YOU'RE HOME		FACILITY NUMBER:	374604456
ADMINISTRATOR:	SAYRE, LISA HENDERLING		FACILITY TYPE:	740
ADDRESS:	5971 LAKE MURRAY BLVD.		TELEPHONE:	(619) 466-6993
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	6	CENSUS: 5	DATE:	07/17/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Caregiver Gabriela Macias		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff neglect resulted in resident injury
Staff verbally intimidated resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegations. LPA identified herself and discussed the purpose of the visit with Caregiver Gabriela Macias. Administrator joined by telephone.

On June 21, 2023, Community Care Licensing (CCL) received a complaint alleging staff neglect resulted in resident injury and staff verbally intimidated resident.

During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. Based on Resident 1 (R1) Physician’s Report dated February 8, 2023, R1 has a history of skin breakdown and can communicate needs. According to allegations, Staff 1 (S1) stepped on R1’s foot causing injury. Records collected revealed that R1 is receiving wound care to foot. Records also revealed that R1 had such wound open greater than six months due to trauma to fall.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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 2

Control Number 08-AS-20230621104010

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: SAY YOU'RE HOME	FACILITY NUMBER: 374604456
	VISIT DATE: 07/17/2023

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

Facility records revealed that resident has lived at the facility since March of 2023, which is less than six months. Interview with outside source present on the date of the incident revealed that S1 was not seen stepping on R1. During investigation, there was no corroborating information found to determine R1 was injured by S1.

It was also alleged that S1, S2 and S3 entered R1’s room to intimidate resident into changing story regarding being stepped on. Interview with R1 revealed that no such incident occurred, and no staff have intimidated R1. Interview with outside source revealed there have been no other allegations or incidents regarding residents being intimidated at facility. Interviews with multiple outside sources revealed the facility has no history of staff being intimidating to residents.

Based on LPA's interviews with staff, outside source interviews, and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Caregiver Gabriela Macias, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2