374600980-4-28-2023-08-AS-LTEZ-CRC3MQ-20230428182242

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600980
Report Date: 04/28/2023
Date Signed: 04/28/2023 11:57:00 AM

Unfounded

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
04/03/2023 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20230403142252

FACILITY NAME:	CASA DE CASTRO II		FACILITY NUMBER:	374600980
ADMINISTRATOR:	CHERYL CASTRO		FACILITY TYPE:	740
ADDRESS:	7766 PRAIRIE MOUND WAY		TELEPHONE:	(619) 475-7525
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Cheryl Castro via telephone		TIME COMPLETED:	11:05 AM

ALLEGATION(S):

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Licensee did not provide a safe environment for resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced visit to conclude a complaint investigation and deliver investigative finding in response to the above-listed allegation. LPA identified herself, was granted entry, and stated the purpose of the visit to Emelita Supnet, staff. Cheryl Castro, Licensee, was contacted via telephone.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of a tour of the facility and interviews with facility staff and outside source.

It was alleged that a safe environment was not provided to a resident in care when Resident 1 (R1) engaged in a behavioral disturbance in the home, during which R1 attempted to enter another resident’s bedroom, threatened, and attempted to attack the resident. Interviews conducted during the investigation confirmed that R1 had a behavioral episode in the early morning hours on March 29, 2023. Interviews further revealed

Unfounded

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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-20230403142252

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: CASA DE CASTRO II	FACILITY NUMBER: 374600980
	VISIT DATE: 04/28/2023

NARRATIVE

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that, during the incident, R1 attempted to enter the bedroom of facility staff and directed aggression toward and targeted a staff who was in the staff bedroom. It was discovered that other residents in the home were in their respective bedrooms when the incident occurred, and no residents were verbally or physically targeted during the incident. The investigation yielded that R1 had calmed down and returned to baseline shortly after the incident occurred. The investigation also yielded that R1 was transported from the home the same morning without incidence or harm to any other residents in care.

Based upon the foregoing, which reflects that a staff, not a resident, was the target of the reported incident, the complaint allegation is unfounded, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, as to the above listed allegation, based on information obtained, the facility is in compliance with Title 22 regulations at this time, and the complaint has been dismissed.

An exit interview was conducted, via telephone, with Cheryl Castro, and copies of this report and Licensee/Appeal Rights (LIC9058) were provided to staff at the conclusion of the visit. Emelita Supnet's signature on this report acknowledges receipt of copies of the rights and report.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC9099 (FAS) - (06/04)

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