374604501-6-20-2023-08-AS-SJAB-CT7KPQ-20230627080504

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604501
Report Date: 06/20/2023
Date Signed: 06/20/2023 02:07:05 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
05/24/2023 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20230524090856

FACILITY NAME:	DEL REY SPRINGS		FACILITY NUMBER:	374604501
ADMINISTRATOR:	GONZALEZ, EDUARDO		FACILITY TYPE:	735
ADDRESS:	1181 PLAZA AMPARADA		TELEPHONE:	(619) 990-8870
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY:	4	CENSUS: 3	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	01:50 PM
MET WITH:	Jacqueline Serrano		TIME COMPLETED:	02:33 PM

ALLEGATION(S):

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Staff abandoned client at the hospital.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Caregiver Jacqueline Serrano and we discussed the purpose of the visit and elements of the complaint.

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

It was reported to CCL that on May 22, 2023 Client 1 (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients) was abandoned at the hospital. It was alleged that facility staff refused to pick up C1 after he was cleared to return back to the facility. LPA investigation revealed C1 was admitted to the hospital on the evening of May 22, 2023 and returned to the facility on May 23, 2023 after C1 was discharged.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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-20230524090856

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: DEL REY SPRINGS	FACILITY NUMBER: 374604501
	VISIT DATE: 06/20/2023

NARRATIVE

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Interview with facility staff revealed they had no issues admitting C1 to the hospital on May 22, 2023. Staff stated that they spoke with a hospital staff member on May 23, 2023 who stated that C1 needed to be picked up. Staff advised the hospital staff member that the facility clients and staff were on an outing and no one was at the facility to receive C1. Staff further stated that they later contacted the hospital to advise them that they would be picking up C1. The hospital declined and instead dropped off C1 at the facility themselves.

Interview with C1 revealed C1 did not enjoy their brief stay at the hospital. C1 stated that they had no problems or issues returning back to the facility after they were discharged from the hospital. C1 stated that they were able to "come back right away from the hospital."

Interview with outside agency revealed they were contacted by the hospital to assist with getting C1 back to the facility. Outside agency stated that they were advised that the hospital could not reach the licensee or administrator via telephone. Outside agency provided the hospital with the facility phone number and was advised that a staff member agreed to pick up the client the same day. Outside agency stated that they do not believe C1 was abandoned at the hospital.

Interview with Licensee on June 13, 2023 revealed C1 was admitted to the hospital on May 22, 2023 due to a violent outburst. Licensee stated that their was miscommunication involving the return of C1 to the facility. Licensee stated that the facility staff were on an outing with the clients and no one was at the facility to receive C1. Licensee further stated that at no time did any staff advise the hospital that C1 would not be allowed back at the facility. Licensee stated that C1 moved out of the facility on June 1, 2023.

Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid.

An exit interview was conducted with Jacqueline Serrano. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Jacqueline Serrano whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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