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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604637
Report Date: 09/25/2023
Date Signed: 09/25/2023 10:40:54 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
08/18/2023 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20230818094607
FACILITY NAME:BRAMBLEWOOD ARFFACILITY NUMBER:
374604637
ADMINISTRATOR:NOVAK, PARLARFACILITY TYPE:
735
ADDRESS:1261 PERSHING ROADTELEPHONE:
(619) 392-5802
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:6CENSUS: 6DATE:
09/25/2023
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Isamar MartiracostaTIME COMPLETED:
10:53 AM
ALLEGATION(S):
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Staff yelled at a client while in care

Staff behavior posed as a risk to a client while in care
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 Isamar Martiracosta and we 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 agency.

It was reported to CCL that a staff member violently yelled at Client 1 (C1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the clients). It was also alleged that facility staff (S1) behavior posed a risk to C1. LPA interview with C1 revealed C1 is 24 years old and is waiting to be accepted to program. C1 stated that C1 "likes the facility." C1 further stated that C1 has total hearing loss in right ear. C1 also stated that C1 cannot hear sometimes due to their ADHD diagnosis. C1 stated that S1 raises their voice at C1 when S1 is trying to get C1's attention.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
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-20230818094607
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: BRAMBLEWOOD ARF
FACILITY NUMBER: 374604637
VISIT DATE: 09/25/2023
NARRATIVE
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Interview with C2 revealed C2 is 31 years old and enjoys living at the facility. C2 stated that C1 "cusses" every morning and complains about another clients perfume. C2 further stated that S1 raises her voice sometimes when she is trying to explain herself. C2 stated that S1 raises her voice sometimes because the house is "loud" when everyone returns from program.

Interview with S1 revealed S1 has worked at the facility for 3 years as a caregiver. S1 stated that C1 can never hear or understand her due to the headphones she wears all day. S1 stated that as a result, she has to speak with a louder voice to C1. S1 stated that the other clients tend to get upset with C1 since C1 is "super loud" when she is on the phone. S1 stated that a few weeks ago C1 was banging on the kitchen counter and S1 asked her to stop. C1 then got upset and went to her room. S1 stated that she has been cursed at by C1 and at times does not know if C1 is going to turn violent.

Interview with outside agency (OA) revealed that C1 can be very dramatic when C1 gets frustrated and can go from "0 to 100 really quick." OA stated that they spoke with C1 on August 18, 2023 and were advised by C1 that things "were going well." OA stated that they do not believe S1 screams at the clients or is an ongoing issue at the facility.

Interview with Licensee revealed that C1 can be very loud and inappropriate in front of the other clients. Licensee stated that the other clients became increasingly upset with C1's behavior and as a result she has looked into C1 transferring to another facility. Licensee stated that she has conducted several "town hall" meetings with all of the clients and as of right now C1 has shown some improvement. Licensee further stated that S1 is well liked by all of the clients and does not violent yell at any of the clients in care.

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

An exit interview was conducted with Isamar Martir Acosta. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Isamar Martir Acosta whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2