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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006103
Report Date: 10/10/2024
Date Signed: 10/10/2024 03:04:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
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 Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20241004112631
FACILITY NAME:CASA FRANCESCAFACILITY NUMBER:
306006103
ADMINISTRATOR:OLIVA, MARIZAFACILITY TYPE:
740
ADDRESS:2942 CALLE GRANDE VISTATELEPHONE:
(949) 240-6889
CITY:SAN CLEMENTESTATE: CAZIP CODE:
92672
CAPACITY:6CENSUS: 4DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
02:21 PM
MET WITH:Mariza OlivaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff are smoking marijuana on facility premises while on duty
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the visit, LPA toured the facility and interviewed staff and Administrator. Regarding the allegation that staff are smoking marijuana on facility premises while on duty, the investigation revealed the following: Interview with Staff 1 (S1) confirmed smoking marijuana on the patio at the facility. S1 stated smoking in the evening after residents have gone to bed. S1 is on-call throughout the night to assist residents as needed. Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the allegation is found to be SUBSTANTIATED. Facility is being cited per California Code of Regulations Title 22, Division 6, Chapter 1.
An exit interview was conducted and a copy of this report as well as appeal rights were provided at exit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
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)
Page: 1 of 2
Control Number 22-AS-20241004112631
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CASA FRANCESCA
FACILITY NUMBER: 306006103
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/11/2024
Section Cited
CCR
87411(f)
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All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. This req is not being met as evidenced by:
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Licensee to provide an in-service regarding marijuana smoking at the facility and forward proof to LPA by POC due date.
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Based on interview conducted, Licensee failed to ensure staff are mentally capable of performing work tasks. S1 is smoking marijuana at the facility. This poses an immediate health and safety risk to residents 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: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2