374604501-1-29-2024-08-AS-DPOL-D2225W-20240131160614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604501
Report Date: 01/29/2024
Date Signed: 01/29/2024 11:36:49 AM

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
09/11/2023 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20230911043638

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: 4	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	09:59 AM
MET WITH:	Jeremiah Letuligasenoa		TIME COMPLETED:	11:46 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not treat client with dignity.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with DSP Jeremiah Letuligasenoa 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 LPA observations and interviews with clients, facility staff and outside sources.

It was alleged that facility staff did not treat Client 1 (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients) with dignity. It was reported to CCL that facility staff spoke to C1 with an agressive tone and slammed a blender on the kitchen counter. LPA interviewed C1 at the facility. C1 stated that one day Staff 1 (S1) was helping another client when C1 approached S1 and asked to use the blender. C1 stated that S1 raised their voice and put down the blender forcefully on the counter. C1 stated that it is no longer a problem or an issue since S1 no longer works at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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-20230911043638

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: 01/29/2024

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

Interview with Client 2 (C2) revealed they have lived at the facility for four months. C2 stated that they "love the house and love the house staff." C2 further stated that S1 is "amazing." C2 stated that C2 has never heard S1 yell at anyone. C2 stated that staff work their "butt off."

Staff 1 (S1) stated S1 began working at the facility in October 2022. S1 stated that despite initial challenges with clients in following directions, rules, or routines, the overall experience has been rewarding, particularly in assisting clients in reaching their personal goals. S1 stated that C1 seems to struggle with early morning routines and often expresses displeasure when prompted to start C1's daily activities. This has occasionally resulted in a negative mood and reluctance to cooperate. S1 stated that on one occasion, C1 used inappropriate language and cursed at S1 when S1 had difficulty preparing C1's shake. S1 further stated that S1 may have raised S1's voice on occasion for communication purposes, but it has never been out of frustration or anger and S1 cannot recall any incident of slamming a blender.

LPA interviewed Outside Agency (OA). OA stated that C1 never informed OA of the alleged incident involving S1. OA stated that C1 does not share much with OA when OA has inquired about C1's living conditions. OA last met with C1 in August 2023 and C1 stated that "everything was fine" with no issues or concerns to discuss. OA stated that S1 is a caregiver that was either transferred to a different facility or was terminated. OA has rarely seen or interacted with S1 and never heard any previous complaints regarding S1 yelling at clients in the facility.

Interview with Administrator I (AI) revealed they were not aware of any incident involving C1 and S1. AI stated that they conduct daily check ins with C1 and ask how
C1 is doing. C1 mentioned that C1 does not like to be woken up in the morning and
because of that they came up with a plan for C1's morning routine. C1 has been very selective and partial to certain staff, and we have been able to assist and encourage C1 on becoming more independent.

LPA interviewed Administrator II (AII). AII stated that AII has worked closely with both C1 and S1. AII stated that C1 tends to become defensive whenever he is told something. AII described an incident where AII advised C1 that pork rinds were not "vegan" and advised C1 that C1 should not be eating them because C1 was vegan. AII stated that C1 became very upset. AII further stated that C1 tends to think that all of the conversations in the facility are about C1 and as a result C1 takes "everything personal" no matter who or what the conversation is about.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20230911043638

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: 01/29/2024

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

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 Jeremiah Letuigasenoa. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Jeremiah Letuligasenoa whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3