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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802865
Report Date: 05/30/2023
Date Signed: 05/30/2023 02:57:41 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
03/06/2023 and conducted by Evaluator Liliana Silveira
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230306093454
FACILITY NAME:ORLANDO GUEST HOMEFACILITY NUMBER:
370802865
ADMINISTRATOR:CYRALYNN MABALOTFACILITY TYPE:
735
ADDRESS:297 -299 ORLANDOTELEPHONE:
(619) 444-9411
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:34CENSUS: 34DATE:
05/30/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Fe Martinez, Assistant AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
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5
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9
Lack of supervision resulting in client inappropriately touching another client.
INVESTIGATION FINDINGS:
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2
3
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5
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9
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12
13
Licensing Program Analyst (LPA) Liliana Silveira conducted a complaint investigation visit to deliver findings for the above-mentioned allegations. LPA Silveira met with Fe Martinez, Assistant Administrator, and shared the findings.

The Department’s investigation consisted of interviews and records review. On 03/26/23 it was alleged that lack of supervision resulted in a client (Client #1, C1) inappropriately touching another client (Client #2, C2). A records review revealed that both C1 and C2 are highly independent individuals with a high capacity for self-care. An interview with C2 revealed that they liked living at the facility and while a minor incident did occur, it was addressed immediately by the facility. Interviews with other clients revealed that there were no concerns regarding safety issues at the facility. Interviews with staff and the Administrator revealed that due to a change in condition that required a higher level of care, C1 was no longer residing at the facility and would not be returning. There was insufficient evidence to corroborate this allegation. (CONTINUED ON LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
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-20230306093454
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: 05/30/2023
NARRATIVE
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Due to lack of corroborating evidence, the findings regarding the above allegation were established to be unsubstantiated. This finding means that although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation 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 documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2