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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602117
Report Date: 06/29/2022
Date Signed: 06/29/2022 02:27:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
07/27/2020 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20200727120748
FACILITY NAME:TOMAS RESIDENTIAL CAREFACILITY NUMBER:
374602117
ADMINISTRATOR:NORMA TOMASFACILITY TYPE:
740
ADDRESS:6344 JOUGLARD STTELEPHONE:
(619) 434-5235
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 3DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Norma Tomas, AdministratorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Illegal Eviction
INVESTIGATION FINDINGS:
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On 06/29/22 at about 12:30 PM, Licensing Program Analyst (LPA) Daniel Pena conducted a complaint follow up visit to conclude this investigation. LPA was met at the front door by Aministrator, Norma Tomas. After identifying himself and explaining the reason for the visit, LPA was permitted into the facility. LPA explained to Ms. Tomas the purpose of the visit was to deliver findings on the above-mentioned complaint. LPA was later joined by Licensee, Abraham Tomas.

The Department's investigation consisted of interviews with staff, outside sources, and record reviews. It was alleged that Resident 1 (R1) was illegally evicted from the facility. Licensee, Tomas was provided with Confidential Names Form in order to identify R1 (LIC811).

Investigation revealed that on July 11, 2020, R1 eloped from the facility and was hospitalized on the same day. During the inpatient stay, hospital staff contacted the facility to discuss R1’s discharge plan. Interview with the Licensee revealed he refused to accept R1 back into care because of a fear of COVID-19 exposure, which prompted the facility’s eviction of R1. Interview with the Licensee also
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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 08-AS-20200727120748
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: TOMAS RESIDENTIAL CARE
FACILITY NUMBER: 374602117
VISIT DATE: 06/29/2022
NARRATIVE
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confirmed the Licensee did not conduct a reappraisal of R1 nor did they provide R1 or their designated representative with a written 30-day notice of eviction. Facility records reviewed by the LPA revealed no eviction notice was ever issued as well.

The Department has investigated the allegation of illegal eviction and has found that, based upon evidence gathered through interviews and records reviewed, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated. This deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted with Mr. Tomas. A copy of this report, LIC-9099, LIC-9099D, and Licensee Rights (9058 01/16) were left with the Licensee, whose signature on this form confirm receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20200727120748
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: TOMAS RESIDENTIAL CARE
FACILITY NUMBER: 374602117
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
87224(a)(4)
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87224(a)(4) EVICTION PROCEDURES If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement was not met as evidenced by:
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Licensee to review Title 22 Eviction Procedures with all staff and provide CCLD with written evidence of completion by POC date.
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Based upon record review and interviews, the licensee did not serve a lawful written 30-day eviction notice and did not conduct a reappraisal prior to issuing the notice in one of six residents in care. This posed a potential personal rights 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: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3