374604699-10-10-2024-08-AS-LTEZ-DAL2GR-20241031172335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604699
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:29:58 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
10/04/2024 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20241004154227

FACILITY NAME:	EUREKA HOME		FACILITY NUMBER:	374604699
ADMINISTRATOR:	GONZALEZ, JOSE ADAN, JR		FACILITY TYPE:	735
ADDRESS:	10746 EUREKA		TELEPHONE:	(619) 832-6229
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91978
CAPACITY:	4	CENSUS: 3	DATE:	10/10/2024
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Jose Gonzalez, Administrator		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff did not respond promptly to communication regarding a resident's condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Jose Gonzalez, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Administrator.

On October 4, 2024, the department received a complaint regarding facility staff did not respond promptly to communication regarding a resident's condition. The Department investigated the complaint allegation. The investigation consisted of a tour of the facility, an interview with staff, and a records review.

On October 3, 2024, Resident 1 (R1) was involved in a behavioral incident at school. According to the school's report, the resident exhibited aggressive behavior, which culminated in the physical pushing of a teacher.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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-20241004154227

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: EUREKA HOME	FACILITY NUMBER: 374604699
	VISIT DATE: 10/10/2024

NARRATIVE

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As a result of this behavior, the resident was suspended from school. Following the incident, the school attempted to contact the facility administrator to arrange for the resident to be picked up. Multiple calls were made to the administrator; however, no answer or response was received.

Due to R1's behavior and the inability to reach the administrator, R1 left the premises and the school escalated the matter to the Sheriff’s Department. Law enforcement officers arrived on-site, and after an assessment, the decision was made to transport the resident to the Emergency Room under a 5150 hold for psychiatric evaluation. Two days later the hospital cleared the resident for discharge. The administrator was contacted to pick up the resident from the hospital.

The investigation into the administrator’s failure to answer the phone was initiated after reports indicated that the school and law enforcement had experienced difficulties in reaching the administrator during the initial incident. However, the following findings were made: There were missed calls during the time of the incident. However, the administrator stated that he was doing yard work and unaware of the calls, the phone was being charged due to low battery. At 1:30 PM the Administrator called the Sheriff's department first then called the school. Once the administrator checked his phone and became aware of the situation the administrator responded promptly.

Based on the evidence gathered during the investigation, the allegation that the facility administrator failed to respond to the school’s phone calls, resulting in the resident being taken to the ER under a 5150 hold, is unsubstantiated. The administrator's inability to answer the phone during the initial incident was due to work being done in the yard and the phone being charged and they took appropriate action as soon as they were made aware of the situation. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Jose Gonzalez, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and his signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC9099 (FAS) - (06/04)

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