370802865-11-29-2022-08-AS-DPOL-CLNSK6-20221130125612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802865
Report Date: 11/29/2022
Date Signed: 11/29/2022 09:56:50 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, 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
02/14/2022 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220214075946

FACILITY NAME:	ORLANDO GUEST HOME		FACILITY NUMBER:	370802865
ADMINISTRATOR:	CYRALYNN MABALOT		FACILITY TYPE:	735
ADDRESS:	297 -299 ORLANDO		TELEPHONE:	(619) 444-9411
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	34	CENSUS: 34	DATE:	11/29/2022
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Fe Martinez, Assistant Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff mismanaged client's medication.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegation. LPA Silveira met with Fe Martinez, Assistant Administrator and shared the findings.

The Department’s investigation consisted of interviews and records review. On 02/14/22, it was alleged that facility staff mismanaged the client’s medication by providing the client with medication when the client was out of the facility.

A records review revealed that the client was highly independent and living independently. The records review, as well as interviews with outside sources and the Administrator, revealed that during the period in question, the client had a behavioral episode and was transitioning between living independently and moving back to the facility. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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 08-AS-20220214075946

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: ORLANDO GUEST HOME	FACILITY NUMBER: 370802865
	VISIT DATE: 11/29/2022

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 client was spending days at the previous apartment and days at the facility. Interviews with the Administrator and staff revealed that while the facility was beginning to manage the client’s prescribed medications, the client had missed several days of medications due to absence from the facility.

The interview with the Administrator revealed that when the client was approached about the missed medications, the client stated that they “already had meds.” The incident was reported to the client’s case manager. Interviews with staff also revealed that no medications were provided to the client to take out of the facility during the period in question. There was insufficient evidence to support this allegation.

Due to lack of corroborating evidence, the findings regarding the above allegations were established to be unsubstantiated. This finding means that although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Silveira conducted an exit interview with Fe Martinez. At the time of the exit interview Fe was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) and signature on this report acknowledges receipt of the rights.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2