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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604481
Report Date: 01/27/2025
Date Signed: 01/28/2025 08:43:04 AM

Substantiated


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
06/12/2024 and conducted by Evaluator Alyssa Ramirez
COMPLAINT CONTROL NUMBER: 08-AS-20240612140214
FACILITY NAME:COLUMBIA RESIDENTIAL CARE LLCFACILITY NUMBER:
374604481
ADMINISTRATOR:CHANEL BERNARTEFACILITY TYPE:
735
ADDRESS:1610 COLUMBIA STREETTELEPHONE:
(858) 294-3670
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:4CENSUS: 4DATE:
01/27/2025
UNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Administrator Chanel BernarteTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Administrator Chanel Bernarte and discussed the purpose of the visit and elements of the complaint.

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

It was reported to CCL that facility issued an unlawful eviction was given to client (C1).
A review of records revealed that C1 was issued a 30 day eviction, with listed reasons involving C1’s refusal to services.

Continued on LIC 9099- C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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-20240612140214
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: COLUMBIA RESIDENTIAL CARE LLC
FACILITY NUMBER: 374604481
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2025
Section Cited
CCR
85068.5(a)(3)
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The licensee shall be permitted to evict a client by serving with a 30-day written notice to quit for any of the following reasons: (3) failure of the client to comply with the genera; facility policies as specified in the Admission Agreement.”
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Staff will review eviction regulations & POC due date.
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Based on interviews and record review the licensee did not issue a lawful eviction notice for 1 out of 4 clients [C1] in care which posed a potential personal rights violation.
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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: Robyn Clark
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240612140214
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: COLUMBIA RESIDENTIAL CARE LLC
FACILITY NUMBER: 374604481
VISIT DATE: 01/27/2025
NARRATIVE
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 A review of facility house rules revealed no requirement for mandatory participation in services as a condition of admission. Regulation 85068.5 states that “The licensee shall be permitted to evict a client by serving the client with a 30-day written notice to quit for any of the following reasons” failure of the client to comply with the general facility polices as specified in the admission agreement.” A review of facilities admission’s agreement revealed no policy stating that residents must participate in services.

The departments review of the available evidence revealed that the preponderance of evidence standard was met and the allegation was SUBSTANTIATED. A deficiency was cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099-D. A plan of corrections was developed with Administrator.

An exit interview was conducted with Administrator to whom a copy of this report and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3