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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800061
Report Date: 06/28/2024
Date Signed: 06/28/2024 11:55:35 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/15/2023 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20231215162848
FACILITY NAME:C.A.L.L.-SAN ANTONIO HOUSEFACILITY NUMBER:
405800061
ADMINISTRATOR:JONI CHAPMANFACILITY TYPE:
735
ADDRESS:13600 SAN ANTONIOTELEPHONE:
(805) 466-6274
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:6CENSUS: DATE:
06/28/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Sean Dietech, Exective Director of CALLTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff physically abused resident while in care which resulted in dislocation
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility above to issue final findings. LPA met with Sean Dietech Exective Director of CALL and explained the purpose of the visit.

During the initial visit on 12/18/2023, LPA Jeffries toured the facility and obtained relevant documents. Community Care Licensing (CCL) Investigations Branch (IB) Investigator Romelia Munoz conducted the investigation. Investigator conducted interviews with relevant parties on 1/3/24 from 9:00am to 11:00am and reviewed documents and photographs.

On the allegation: Staff physically abused resident while in care which resulted in dislocation. It was alleged staff abused Client 1 (C1), resulting in dislocations. It was alleged C1’s wrist was dislocated because the wrist bone was “popping out,” and their neck was dislocated because it was bent.
Conintued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
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 2
Control Number 29-AS-20231215162848
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: C.A.L.L.-SAN ANTONIO HOUSE
FACILITY NUMBER: 405800061
VISIT DATE: 06/28/2024
NARRATIVE
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Witness 1 (W1) stated on 11/11/2023, they observed C1 had mittens on, and after taking them off, they observed C1’s wrist and neck to be dislocated. W1 believed staff “yanked” on C1 in a rough or physically abuse manner, resulting in the injuries. W1 stated C1’s wrist was also red, and provided photographs taken. Investigator reviewed the photographs and observed slight redness to the right wrist. W1 stated C1 has a habit of sitting on their hands and rocking back and forth. W1 touched C1’s right wrist and C1 did not appear to be in pain. C1 also picked up a hamburger with their hands and ate a few bites during the visit. W1 stated they had concerns about C1’s neck but did not believe it was dislocated. However, W1 stated C1’s posture has worsened over time and C1’s neck faces down while seated. W1 stated during the visit, C1 was able to walk on their own and seemed to be enjoying themselves. W1 also stated they did not have concerns that C1 was being physically abused, but believed the redness on the wrist could be caused by staff grabbing C1. W1 stated the administrator indicated the redness was due to a lotion used on C1’s wrists, and C1 wears mittens for their own protection.

C1’s conservator stated they visit C1 at the facility on a quarterly basis and is familiar with C1, their needs, the facility and the staff. C1’s conservator had no concerns about C1’s safety at the facility and believes all C1’s needs are being met. C1’s conservator stated no recent injuries had been reported to them.

The investigation did not reveal any documents or incident reports suggesting C1 had a dislocated wrist or neck. Administrator also stated C1 never had a dislocated wrist or neck while at the facility. Administrator provided medical paperwork with X-Ray showing C1 had no dislocation or fracture present.

Based on the information obtained, there was insufficient evidence to prove the allegation above. Therefore it is deemed Unsubstantiated at this time.

Exit interview conducted and report printed for Executive Director.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2