<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004174
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:07:45 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
09/07/2021 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20210907084102
FACILITY NAME:DUELAS GUEST HOMEFACILITY NUMBER:
306004174
ADMINISTRATOR:LILIA DUELASFACILITY TYPE:
735
ADDRESS:10721 VICKERS DRIVETELEPHONE:
(714) 638-8219
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:6CENSUS: 3DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Idelma SantosTIME COMPLETED:
02:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad to investigate the above-mentioned complaint allegation. LPA met with Staff member #1 (S1) Idelma Santos, discussed the purpose of the inspection, explained the allegation, and conducted the investigation. Administrator (AD) Lilia Duelas was not present during the inspection but appeared via telephone.

The investigation into the allegation of Neglect/Lack of Supervision revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, and requested and reviewed resident documents. It was reported that Resident #1 (R1) has issues urinating on themselves, smelling of urine, and their room smelling of urine. LPA’s interview with AD corroborated these facts. R1 has lived at the facility for 12 years and has had issues with urination for about 2 years. AD has taken some steps to address the issue, including seeking advice from medical professionals and responsible parties, but no progress has been made on the issue.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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 22-AS-20210907084102
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: DUELAS GUEST HOME
FACILITY NUMBER: 306004174
VISIT DATE: 09/09/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility is a level 2 facility and only has 1 caregiver working at any one time. The caregiver on duty also does the housekeeping and cooking. During the inspection, LPA observed urine stains on the cushions of chairs in the facility. Although AD has made some attempts to address the urination issue, insufficient progress has been made and thus the allegation that the facility is not providing an adequate level of care and supervision is substantiated.

During the course of the investigation, CCLD obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report as well as appeal rights was left at the facility.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20210907084102
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: DUELAS GUEST HOME
FACILITY NUMBER: 306004174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2021
Section Cited
CCR
80078(a)
1
2
3
4
5
6
7
80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
During today’s inspection, Licensee provided a plan to LPA to address R1’s urination issue, which includes requesting relocation to a higher level of care or providing additional care and supervision at the facility. Licensee stated they will notify LPA of the status of relocation or a specific and detailed plan to address the issue at the facility within 30 days of POC due date.
8
9
10
11
12
13
14
Based on interviews, the licensee did not ensure R1’s needs were met by allowing R1’s urination issue to continue for 2 years, which poses an immediate health and personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3