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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808112
Report Date: 08/19/2021
Date Signed: 09/02/2021 02:15:14 PM

Substantiated


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
06/26/2020 and conducted by Evaluator Adam Hamer
COMPLAINT CONTROL NUMBER: 08-AS-20200626103912
FACILITY NAME:FANCOR GUEST HOMEFACILITY NUMBER:
370808112
ADMINISTRATOR:HUERTAS, FANNIEFACILITY TYPE:
735
ADDRESS:631-651 TAFT AVENUETELEPHONE:
(619) 588-1761
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:44CENSUS: 44DATE:
08/19/2021
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Cyralynn Mabalot, AdminstratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility did not treat client with dignity.
Facility did not provide clean linens for client.
Insufficient food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced complaint investigation visit on today’s date. LPA identified himself, discussed the purpose of the visit, which was to deliver findings for the above allegations, and was then granted entry. Administrator Cyralynn Mabalot later arrived at the facility and LPA met with her to deliver the findings.

The Department’s investigation included interviews with clients, staff and outside sources, and LPA observations. Facility records and pictures were also obtained by the Department and reviewed for pertinent evidence.

The Department received a complaint on June 26, 2020 alleging that the facility did not treat a client with dignity, did not provide clean linens for client and provided insufficient food service. Interviews with staff, outside sources and a records review revealed that in June 2020, Client #1 (C1) was a client at the facility and was sharing a room with client #2 (C2)(See Confidential Names List – LIC 811). Department interviews and records review revealed that Staff #1 (S1), who was one of the staff responsible for changing C1’s linens, did not change their linens, continued to refuse to do so and yelled at C1, which caused C1 to continue to lay in soiled linens and cry. Staff later reported S1 to management for not changing C1’s linens, then staff #2 (S2) changed the linens at least several hours later.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Adam Hamer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
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 4
Control Number 08-AS-20200626103912
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: FANCOR GUEST HOME
FACILITY NUMBER: 370808112
VISIT DATE: 08/19/2021
NARRATIVE
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Facility records also revealed that the housekeeping staff had a schedule and were assigned to clean different areas of the facility. There were at least two (2) staff at that time who were responsible for cleaning client rooms and changing their linens. Department interviews and pictures of C1’s bed taken in June 2020 revealed that their bed did not have the required bed coverings at the time the pictures were taken.

Although the Department attempted to interview C1, it was discovered that C1 passed away on March 26, 2021 of natural causes. Staff and client expressed during interviews with the Department that C1 asked that her bedding be changed but staff would not change it for at least several hours and yelled at C1. The Department’s interviews with client and staff, and a records review revealed that C2 had shared a room with C1 in June 2020 and that, during this time period, C1 would ask S2 to change their bedding after it was soiled and S2 refused to do so and yelled at C1.

Regarding the food service allegation, the Department reviewed facility records, which included facility menus and staff food handler certificates, and LPA also observed the food being served at different mealtimes. The Department also conducted interviews with staff, clients and outside sources. Interviews with clients and staff revealed that clients were served a variety of foods every day such as hot dogs, corn dogs, frozen burritos, beef enchiladas, chicken, etc. However, many of the foods served were not nutritious, the portions of the foods were small, and clients complained of being hungry after meals. LPA observations revealed that clients were being served hot dogs with chips during one meal and enchiladas with pinto beans during another meal. No fresh fruits or vegetables were served during these meals and the portions were small.

Based on the evidence obtained during the complaint investigation, the allegations that facility did not treat client with dignity, did not provide clean linens for client and provided insufficient food service are found to be SUBSTANTIATED, as there is a preponderance of the evidence to prove that the allegations occurred. Citations are being issued in accordance with California Code of Regulations, Title 22, and are listed on the attacehd LIC9099D, as is the plan of correction that was developed by Administrator Cyralynn Malabot.

An exit interview was conducted with Ms. Malabot, and a copy of this report, the Confidential Names List and Licensee's Rights (LIC 9058 FAS 01/16) were emailed to her; she expressed that she would send a confirmation upon receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Adam Hamer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20200626103912
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: FANCOR GUEST HOME
FACILITY NUMBER: 370808112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited
CCR
80072(a)(1)
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80072. Personal Rights (a) Except for children's residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other persons.
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Administrator will conduct training with staff on clients' personal rights, including according clients with dignity, and submit proof of completion by the POC due date.
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This requirement was not met as evidenced by:
Based on records review and interviews, facility staff did not accord C1 dignity in their personal relationships with staff which posed a potential personal rights risk to 1 out of 44 clients in care.
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Type B
09/16/2021
Section Cited
CCR
85088(c)(4)(A)
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85088. Fixture, Furniture, Equipment, and Supplies. (c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene.
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Administrator will conduct training with staff on ensuring compliance with the provisions of section 85088(c)(4)(A) to ensure that staff provides clean linens for clients at all times, and show proof of completion by the POC due date.
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(4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and washcloths. (A) The quantity of linen provided shall permit changing the linen at least once each week or more often when necessary to ensure that clean linen is in use by clients at all times.
This requirement was not met as evidenced by:
Based on records review, pictures and interviews, facility staff did not provide C1’s clean linens at all times which posed a potential health risk to 1 out of 44 clients 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: Adam Hamer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20200626103912
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: FANCOR GUEST HOME
FACILITY NUMBER: 370808112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2021
Section Cited
CCR
80076(a)(1)
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80076. Food Services. (a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients.
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Administrator will ensure that nutritious quality foods are purchased and served to clients and in adequate portions consistent with USDA recommendations, and provide training to staff. She will also submit
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Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
Based on records review, LPA observations and interviews, facility did not provide food of the quality and in the quantity necessary to meet the needs of the clients, which posed a potential health risk to 44 out of 44 clients in care.
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receipts to the Department for three (3) weeks' food purchased and pictures of the foods served to clients on three different days for three different meal times. All proof should be submitted to the Department by the POC due date.
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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: Adam Hamer
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4