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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802865
Report Date: 03/28/2024
Date Signed: 03/28/2024 12:17:38 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
12/18/2020 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20201218155835
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:
03/28/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Fe Martinez, Assistant AdministratorTIME COMPLETED:
12:37 PM
ALLEGATION(S):
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Clients using illegal substances due to lack of supervision at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegation. LPA gained access to the facility, identified herself, and met with Fe Martinez, Assistant Administrator, to discuss the purpose of the visit.

The initial investigation visit was conducted on Decemeber 21, 2020, and the LPA was able to interview clients,and facility staff. LPA also reviewed records and conducted a physical inspection of the facility. It was alleged that clients are using illegal substances due to lack of supervision at the facility. Interviews revealed that there are clients that have smoked marijuana in their room during the middle of the night without staff checking on them. Interviews revealed they have has seen clients smoke marijuana at the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
12/18/2020 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20201218155835

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:
03/28/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Fe Martinez, Assistant AdministratorTIME COMPLETED:
12:37 PM
ALLEGATION(S):
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9
Facility is in disrepair.
Staff do not provide adequate food service to clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Fe Martinez, Assistant Administratorto discuss the purpose of the visit.

The initial investigation visit on Decemeber 21, 2020 consisted of interviewing clients, and facility staff. LPA Holmes also reviewed records and conducted a physical inspection of the facility. It was alleged that the facility is in disrepair. Interviews revealed that there was a leak in the facility ceiling but the staff fixed the leak after they learned of it. A tour of room #6a and 6b was done on 12/21/2020 and the LPA did not observe there to be a ceiling leak. Observations revealed that the facility appeared to be tidy. Interviews did not reveal there were any odors in the facility. There was no evidence or supporting witness statements to substantiate facility is in disrepair.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20201218155835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ORLANDO GUEST HOME
FACILITY NUMBER: 370802865
VISIT DATE: 03/28/2024
NARRATIVE
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It was alleged that staff do not provide adequate food service to clients. Interviews revealed that there is always fresh food and fruits available for the clients. Interviews revealed the staff provide the meals and the clients are able to have seconds if they want more food. After a tour of the refrigerator/freezer and panned over the food supply the prior LPA observed a couple of baskets of apples and oranges, boxes of vegetables (carrots, broccoli, heads of lettuce), bread, frozen meats, flats of eggs, in addition to various condiments, cheese, and milk. LPA Holmes observed the pantry on today's visit and there was plenty of food and supplies. There was no evidence or supporting witness statements to substantiate staff do not provide adequate food service to clients.

The investigation did not produce supporting evidence or supporting witness statements to substantiate facility is in disrepair and staff do not provide adequate food service to clients. Based on the evidence obtained from interviews, and record review, the complaint allegations are unsubstantiated.

An exit interview was conducted with Fe Martinez, Assistant Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20201218155835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ORLANDO GUEST HOME
FACILITY NUMBER: 370802865
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2024
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by:
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Licensee will provide training to all 11 staff on supervision practices, conducting rounds and the procedures by an outside source. Training materials and sign in sheet will be provided to CCL by 04/08/2024
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Based on interviews, the licensee did not ensure that 1 of 6 clients(C1) was provided care and supervision necessary to meet the client's needs This posed a potential health and safety risk to persons in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20201218155835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ORLANDO GUEST HOME
FACILITY NUMBER: 370802865
VISIT DATE: 03/28/2024
NARRATIVE
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 Interviews revealed they could be street meaning that the marijuana is not a prescription. Interviews revealed that they did not bring this to the attention of staff. There was evidence or supporting witness statements to substantiate clients using illegal substances due to lack of supervision at the facility. Based on the evidence obtained from interviews, and record review, the complaint allegation is substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met.

A deficiency is cited per Title 22 California Code of Regulation. LPA Holmes conducted an exit interview with Fe Martinez, Assistant Administrator, to whom a copy of this report, the LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided. Signature below confirms receipt of the reports.
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SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5