306006191-1-29-2025-22-AS-AJLO-DFUNBM-20250418101923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006191
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:57:03 PM

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
12/03/2024 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241203161555

FACILITY NAME:	HAILEY PRISCILLA HOME		FACILITY NUMBER:	306006191
ADMINISTRATOR:	KABILING, MARIA DOLOR G.		FACILITY TYPE:	735
ADDRESS:	2427 E. LINCOLN AVENUE		TELEPHONE:	(714) 956-5662
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 5	DATE:	01/29/2025
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Perltio Banaticla		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility is not allowing client visitors
Facility did not ensure that staff is treating clients with dignity
Facility is mismanaging clients' medication

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegations mentioned above for the purpose of delivering findings. LPA met with Facility Manager Perlito Banaticla and explained the purpose of the inspection.

Interviews were conducted with two facility staff, three facility clients, and three witnesses regarding allegation facility is not allowing client visitors. Two of two staff interviewed denied visitors are not being allowed. Per Staff 1 (S1), visitors are always allowed, however Witness 3 (W3) has recently been asked not to visit Client 1 (C1) at the request of C1’s family. Per S1, on November 16, 2024, W3 was allowed to visit and went into C1’s room where C1 reported W3 kissed them. During their interview, C1 stated they are allowed visitors with the exception of W3, who kissed them on the cheek three times. Per C1, they do not want to be kissed by W3. During their interview, C2 and C3 stated they are allowed visitors without limitation.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

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 22-AS-20241203161555

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: HAILEY PRISCILLA HOME	FACILITY NUMBER: 306006191
	VISIT DATE: 01/29/2025

NARRATIVE

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Regional Center Representative, Witness 1 (W1) was interviewed and stated they are not aware of visitors being denied visitation at the facility, with the exception of W3. W1 stated W3 has been denied visitation at the request of C1’s family due to concerns of what W3’s intentions with C1 may be and requested W3 not be allowed to spend time with C1. C1’s responsible party, Witness 2 (W2) was also interviewed and stated visitors are allowed at the facility, however, they requested C1 no longer be visited by W3. W2 stated they believe W3’s intentions are sexual in nature and requested facility staff not allow W3 to visit C1. LPA attempted to contact W3 by phone on four occasions to confirm, deny, or provide additional information regarding allegation, however W3 could not be reached.

Interviews were conducted with two facility staff, three facility clients, and three witnesses regarding allegation, facility did not ensure that staff is treating clients with dignity. Two of two staff interviewed stated clients are treated with dignity and denied witnessing or having any knowledge of staff misconduct. Three of three clients interviewed stated they are treated with dignity and denied any concerns regarding inappropriate behavior by any facility staff. During their interview, W1 stated they conducted their own investigation into the allegation, consisting of interviews with clients and staff. Per W1, their investigation did not reveal any wrongdoing by facility staff. During their interview, W2 indicated clients are treated with dignity and denied witnessing or having any knowledge of staff misconduct. LPA attempted to contact W3 by phone on four occasions to confirm, deny, or provide additional information regarding allegation, however W3 could not be reached.

Interviews were conducted with two facility staff, three facility clients, and three witnesses regarding the allegation facility is mismanaging clients' medication. It is alleged facility is administering bedtime medication between 3:30 p.m. – 4:00 p.m. Two of two staff interviewed stated medication is administered following dinner and dinner time is typically between 5:00 p.m. and 6:00 p.m. Per S1, bedtime medication is normally administered at about 7:00 p.m. and clients can go to bed at their own discretion. Three of three clients stated their bedtime medication is administered following dinner, which is typically between 5:00 p.m. and 6:00 p.m., however stated they were unsure of the exact time bedtime medication is administered. During their interview, W1 stated that during their investigation into the allegation, they reviewed Medication Administration Records (MARs) and records were determined to be accurate. W1 stated that per facility staff interviews, medication is given an hour before or an hour after the time stamp on the MAR and for bedtime medication the time stamp is 7 p.m. (Cont. LIC9099-C)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241203161555

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: HAILEY PRISCILLA HOME	FACILITY NUMBER: 306006191
	VISIT DATE: 01/29/2025

NARRATIVE

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During their interview, W2 stated they are unsure of the medication times at the facility, however stated they have a weekly phone call at 4:20 p.m. with C1 and C1 is still awake at that time. Per W2, this indicates C1 has still not taken bedtime medication at that time because the medication will make C1 drowsy and C1 is not drowsy during their call. LPA attempted to contact W3 by phone on four occasions to confirm, deny, or provide additional information regarding allegation, however W3 could not be reached. During investigation visits conducted on December 12, 2024 and today’s date, LPA reviewed medications and MARs for five of five clients and did not observe and discrepancies.

Due to conflicting information received during interview conducted and after clients' records review, LPA is unable to determine if facility is not allowing client visitors, facility did not ensure that staff is treating clients with dignity, or if facility is mismanaging clients' medication. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegations are unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025

LIC9099 (FAS) - (06/04)

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