370804527-5-26-2022-08-AS-SJAB-CEXQDQ-20220531120506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804527
Report Date: 05/25/2022
Date Signed: 05/26/2022 07:06:29 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, 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
10/14/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20201014122643

FACILITY NAME:	LIWAG'S RESIDENTIAL CARE HOME		FACILITY NUMBER:	370804527
ADMINISTRATOR:	NORA B. LIWAG		FACILITY TYPE:	740
ADDRESS:	3993 CASEMAN STREET		TELEPHONE:	(619) 690-1022
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	6	CENSUS: 4	DATE:	05/25/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Licensee Liwag		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff locks resident's inside and outside the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Licensee Liwag to whom was explained the purposes for the visit.

The Department’s investigation consisted of staff and outside source interviews, a facility tour, and a facility record review.

It was alleged that the facility staff lock residents inside and/or outside the facility. An interview with an outside source (OS1) revealed a staff member (S1) was outside the facility on the front patio with a resident and could not gain access back into the facility because the door providing entrance into the facility was locked. OS1 revealed that the facility residents only had access to the living room due to a gate that blocked the residents from entering the facility kitchen, and the only access to enter and exit the facility is through the kitchen.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

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-20201014122643

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LIWAG'S RESIDENTIAL CARE HOME	FACILITY NUMBER: 370804527
	VISIT DATE: 05/25/2022

NARRATIVE

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Interviews with the Licensee revealed they were at the facility with the other residents in care when S1 was out on the patio supervising a resident, S1 did not have their keys so the Licensee allowed S1 and the resident back in. The Licensee also revealed the kitchen gate was installed temporarily. The Licensee revealed the gate was not locked, there was a latch to open and close it, and it was used to delay a resident from entering the kitchen because they touched all the food with their bare hands, and the gate had since been removed. A facility record review and facility tour revealed there were approximately 9 doors providing entrances and/or exits at the facility, and a facility tour corroborated there was no gate that blocked the kitchen. Interviews with outside sources revealed no issues with the facility entry and exit points nor had any complaints regarding the facility or staff.

Based on interviews, a facility record review, and facility tour the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Licensee Liwag and a copy of the Complaint Investigation Report (LIC 9099) and Licensee Rights (LIC 9058 01-2016) was provided to Licensee Liwag and signature on this report acknowledges receipt of the reports.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2022

LIC9099 (FAS) - (06/04)

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