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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800333
Report Date: 01/25/2023
Date Signed: 01/25/2023 03:23:51 PM

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
01/20/2023 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20230120154937
FACILITY NAME:C.A.L.L.-PALOMAR HOUSEFACILITY NUMBER:
405800333
ADMINISTRATOR:REGINA R. CEASARFACILITY TYPE:
735
ADDRESS:8902 PALOMARTELEPHONE:
(805) 462-2421
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:6CENSUS: 6DATE:
01/25/2023
UNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Randyn Torres, AdministratorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff are not providing proper food service.
INVESTIGATION FINDINGS:
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On 1/25/23 at 2:10 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced 10-day complaint visit to the facility listed above. LPA met with Randyn Torres, Administrator, and explained the reason for the visit.

On the allegation, “Staff are not providing proper food service,” the complainant’s concern was that the facility did not provide fresh fruit for clients in care. To investigate, LPA interviewed the administrator and made observations.

At 2:40 pm, LPA made observations and spoke with staff. LPA observed a cantaloupe on the kitchen counter, a bunch of bananas in a storage container in the kitchen, blueberries in the refrigerator. Additionally, there were more than twenty (20) cans of fruit cocktail, mangos, mandarin oranges, pineapple, peaches, and apple sauce. Administrator showed LPA the weekly menu which consisted of fresh fruit. Administrator explains that clients are given fresh fruit almost daily.
Continued on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
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 3
Control Number 29-AS-20230120154937
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.-PALOMAR HOUSE
FACILITY NUMBER: 405800333
VISIT DATE: 01/25/2023
NARRATIVE
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Based on the evidence obtained, the allegation, “Staff are not providing proper food service,” is deemed Unsubstantiated at this time. The facility has a minimum 2-day supply of fresh fruit and minimum 7-day supply of canned fruit.

Exit interview conducted and the report emailed to the executive director and administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3