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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005504
Report Date: 07/30/2024
Date Signed: 07/30/2024 10:17:26 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, 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
06/27/2024 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20240627141202
FACILITY NAME:OUR LADY OF GUADALUPE HOMEFACILITY NUMBER:
306005504
ADMINISTRATOR:CRESENCIA D. SANTIAGOFACILITY TYPE:
735
ADDRESS:24361 BRIDGER RDTELEPHONE:
(949) 328-9784
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 4DATE:
07/30/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Cresencia SantiagoTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Failure to Provide Medical Care
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Cresencia Santiago and explained the reason for today’s inspection.

The investigation into the allegation of failure to provide medical care revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, clients, and witnesses, and obtained and reviewed copies of the client roster, staff roster, the facility’s Medical Appointment Log, Client #1’s (C1) medical records dated June 21, 2024, C1’s medical records dated June 24, 2024, C1’s medical records dated July 1, 2024, C1’s medical records dated July 2, 2024, and facility text messages regarding C1’s rash.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
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 2
Control Number 22-AS-20240627141202
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: OUR LADY OF GUADALUPE HOME
FACILITY NUMBER: 306005504
VISIT DATE: 07/30/2024
NARRATIVE
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It was alleged that that on June 22, 2024, C1 was noted to have a severe rash all over their body and feet and some areas appear as though they bled, that on June 24, 2024, C1’s day program determined C1 could not attend the program due to their severe rash, and that the facility did not notice, provide treatment for, or report the rash to C1’s responsible party. LPA conducted a health and safety check and interviewed C1,but did not obtain information corroborating the allegation. LPA interviewed AD who reported that the facility first noticed the rash in May and had C1 seen by a doctor on May 7, 2024, that C1 was seen by doctors again on June 21, 2024 and July 1, 2024, that C1 was prescribed ointments and other topical medications which have improved the rash, that the facility helped C1 take additional hygienic measures to address the rash, and that facility staff kept C1’s responsible party aware of the situation throughout the treatment and provided pictures to C1’s responsible party. LPA reviewed the facility’s Medical Appointment Log which corroborates that C1 was seen by a doctor on May 7, 2024, and C1’s medical records dated June 21, 2024, June 24, 2024, July 1, 2024, and July 2, 2024, which corroborate that C1 was seen by doctors on all of these dates and received testing and treatment for the rash. LPA reviewed facility text messages regarding C1’s rash exchanged with C1’s responsible party which show C1’s responsible party was made aware of the rash, received photo updates, and participated in decision-making regarding the care for C1’s rash as early as June 3, 2024. Per witness interview, C1’s rash was diagnosed as a staph infection, but C1 never had any major symptoms other than itchiness. Per C1’s medical records dated June 24, 2024, C1 was diagnosed with a staph infection while a portion of the rash was suspected to be fungal in nature. However, C1’s medical records dated July 1, 2024 and July 2, 2024 did not indicate a staph infection and instead indicated that the rash was suspected to be fungal. AD denied that they were aware of the staph infection diagnosis because AD was not the one who took C1 to the doctor on June 24, 2024. Per AD and photographs, the rash resolved after treatment and hygiene measures. The information obtained is conflicting regarding whether C1 was present at the facility with a communicable staph infection and the information obtained did not corroborate that the facility failed or delayed seeking medical care for C1’s rash or failed to notify C1’s responsible party.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC9099 (FAS) - (06/04)
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