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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604371
Report Date: 01/06/2023
Date Signed: 02/03/2023 09:02:35 AM

Substantiated


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
01/03/2023 and conducted by Evaluator Amy Domingo
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230103083735
FACILITY NAME:LEXINGTON HOUSEFACILITY NUMBER:
374604371
ADMINISTRATOR:ASOY-DANIEL, ROSHELLE HANFACILITY TYPE:
740
ADDRESS:180 W. LEXINGTON AVE.TELEPHONE:
(619) 401-7528
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 1DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Megan Bragg, House ManagerTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility locked the perimeter fence gate without approval.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Amy Domingo and Interim Assistant Program Administrator (IAPA) Icela Estrada conducted an unannounced. complaint investigation visit to the facility to deliver findings on the above allegations.

The investigation consisted of interviews with staff, and outside sources in addition to outside source record review, and inspection of the facility. During today's visit, LPA took pictures of items in the facility.

It was alleged that the facility locked the perimeter fence gate without Fire Marshal approval. Interviews with staff revealed that a combination lock was used to lock the perimeter fence due to homeless individuals coming into the premises of the facility. Staff advised that in December the El Cajon Fire Department made a visit the facility and explained that they are not approved to lock the gates.

This is an amended version of the report generated and provided to licensee on 1/6/2023.
(Continue on LIC9099C)

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
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 08-AS-20230103083735
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: LEXINGTON HOUSE
FACILITY NUMBER: 374604371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2023
Section Cited
CCR
87705(l)(2)
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Care of Persons with Dementia
The licensee shall ensure that the fire
clearance includes approval of locked exterior
doors or locked perimeter fence gates.
This requirement is not met as evidenced by:
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Licensee removed the combination locks from
the gates and house manager explained that
they understand that the gates cannot be
locked without Fire Marshal - Fire Clearance
approval. House manager agrees to having the
local Fire Marshal or a vendor provide training
to all staff on fire safety.
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Based on interview and record review, the
licensee did not ensure that the fire clearance
included approval of locked perimeter fence
gates in 2 of 2 gates which posed an immediate Health, Safety, or Personal Rights risk to 2 of 2 persons in care [R1 and R2].
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The training will be scheduled by February 6,
2023 and licensee will provide proof of training
by submitting copies of sign in sheets and
training material.
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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: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230103083735
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: LEXINGTON HOUSE
FACILITY NUMBER: 374604371
VISIT DATE: 01/06/2023
NARRATIVE
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The Department obtained a copy of the El Cajon Fire Department report and confirms they conducted an on site inspection on 12/06/2022 (Work order #1313292) and issued a pre-citation to the facility for locking the

During today's visit, LPAs and IAPA did not observe locks on the gates.

Based on the evidence obtained during the complaint investigation, the allegation was found to be SUBSTANTIATED, as is a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted; a copy of this report along with Licensee Rights LIC 9058 (REV 3/22) were provided to House Manager Megan Bragg and their signature confirms receipt of these documents.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Amy Domingo
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3