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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604700
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:13:24 AM

Substantiated


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
08/08/2024 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20240808174917
FACILITY NAME:INDAYPROGRAMSACFACILITY NUMBER:
374604700
ADMINISTRATOR:MARZEENA, NORAFACILITY TYPE:
775
ADDRESS:615 E LEXINGTON AVETELEPHONE:
(619) 995-3543
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:60CENSUS: 12DATE:
08/15/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Nora Marzeena, AdministratorTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Facility staff did not adequately supervise client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open a complaint on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Nora Marzeena, Administrator to discuss the purpose of the visit.

During the visit, LPA toured the facility, reviewed and obtained copies of facility records. It was alleged that facility staff did not adequately supervise client. Interviews revealed on August 8, 2024, Client 1 (C1) was having a behavior around 8:30 am. C1 was aggitated and the staff were trying to calm them down. Interviews revealed that staff took C1 out front to watch the cars go by on the gated porch. Staff went back in the building to get C1 a snack and by the time they returned, C1 was outside with the San Diego Regional Center (SDRC) worker.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
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-20240808174917
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: INDAYPROGRAMSAC
FACILITY NUMBER: 374604700
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/30/2024
Section Cited
CCR
80078
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by:
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Licensee stated they will attend training along with staff regarding client supervision. Licensee will also provide CCL with a copy of C1s new behavior plan. Proof of training/ sign in sheet & documents and the behavior plan are due by POC due date of 8/30/2024
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Based on interviews the licensee did not provide supervision for 1 out of 12 clients (C1) by not having staff outside with C1. This posed an immediate health and safety risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20240808174917
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: INDAYPROGRAMSAC
FACILITY NUMBER: 374604700
VISIT DATE: 08/15/2024
NARRATIVE
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Interviews revealed that C1 was left alone for about 5 minutes on the porch with their tablet. Interviews revealed they have a facility camera and the time stamps on the camera show C1 outside and the SDRC worker come in gate about 8:54am and then show the other staff bringing a snack for C1 and getting ready to open the door with both the SDRC worker and C1 standing at the door. Interviews with staff revealed that they should not have left C1 outside on the gated porch alone without supervision.

There was supporting witness statements to substantiate facility staff did not adequately supervise client. A deficiency is cited per Title 22 California Code of Regulations.

An exit interview was conducted with Nora Marzeena, Administrator. A copy of this report and the Licensee's Rights (LIC9058 03/22) were provided to Licensee at the end of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3