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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604637
Report Date: 12/11/2023
Date Signed: 12/14/2023 10:23:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
11/09/2023 and conducted by Evaluator Alyssa Ramirez
COMPLAINT CONTROL NUMBER: 08-AS-20231109153712
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: 5DATE:
12/11/2023
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Parla NovakTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff do not ensure that resident is accorded privacy.

Staff do not ensure that resident has access to food in a timely manner.

Staff does not ensure facility is free of insects.
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 licensee Parla Novak 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 agency.

It was reported to CCL that a staff do not ensure that resident is accorded with privacy, staff do not ensure that resident has access to food in a timely manner and staff do not ensure that facility is free of insects.

LPA’s interview with C1 revealed that C1 has privacy when using the bathroom. C1 reported that they would like their own room so that they can have privacy to talk on the phone.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
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-20231109153712
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: BRAMBLEWOOD ARF
FACILITY NUMBER: 374604637
VISIT DATE: 12/11/2023
NARRATIVE
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C1 stated they like the food at the facility and sometimes purchases their own food. C1 reported that they are provided with meals and snacks. C1 reported that the facility is clean and stated there are no bugs in the facility.

Interviews with facility staff revealed that there are no concerns for insects in the facility. Staff reported that there is always a menu posted and meals and snacks are always provided to all clients.

Interview with outside agency (OA) revealed that they have not heard about any issues surrounding safeguarding client privacy or insects in the facility. OA reported that they have not witnessed any insects in the facility.

Interview with Licensee revealed that there is no issue with insects in the facility and reported that they have a monthly subscription with Corky’s Pest Control to service the facility monthly for insects. Licensee provided LPA with receipt for recurring bill with Corky’s Pest Control for services rendered. Licensee reported there is always sufficient food supply in the facility and a menu is always posted in the kitchen. Licensee reported that sometimes C1 will decline the food that is offered and will decline any options that are offered. Licensee said that C1 sill sometimes only wants to eat ice cream and chips. Licensee reported that the only issue with according client’s privacy is when C1 pulls other client’s out of the downstairs bathroom because C1 says they do not want to walk upstairs to the other bathroom.

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 licensee Parka Novak. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to licensee whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2