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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880546
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:19:05 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,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/04/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200804111522
FACILITY NAME:ESTANCIA DEL SOLFACILITY NUMBER:
331880546
ADMINISTRATOR:NANCY HALLECKFACILITY TYPE:
740
ADDRESS:2489 CALIFORNIA AVETELEPHONE:
(949) 242-1400
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:135CENSUS: 125DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Lisa Hunt, Exectuiv e DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not properly assess residents needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation listed above. LPA met with Lisa Hunt and explained the purpose and visit and the elements of the allegation. Regarding the allegation of staff did to properly assess resident’s needs.

It was reported that on or around 7/30/2020 Resident #1 (R1) was found deceased by Staff #1 (S1). S1 alerted Staff # 2 (S2) who responded and was reported to have refused to perform CPR as R1 had vomit and feces on their body. Staff 3 (S3) also responded and had instructed for R1's body to be moved to the floor. As a result of the alleged incident facility administration conducted an internal investigation. Per the administrator Lisa Hunt, when S1 discovered R1s deceased, emergency medical personnel was contacted and responded to the facility, as well as the local police department. Per Ms. Hunt local police department gave permission for R1’s body to be released to the coroner without further investigation. Based on observation and interviews the allegation of staff did not properly assess residents needs is UNSUBSTANTIATED. ***Continued on 9099C***.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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 18-AS-20200804111522
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: ESTANCIA DEL SOL
FACILITY NUMBER: 331880546
VISIT DATE: 06/20/2023
NARRATIVE
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A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and a copy of this report was provided to Lisa Hunt, Executive Director.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2