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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808112
Report Date: 09/02/2022
Date Signed: 09/02/2022 12:28:38 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
06/09/2022 and conducted by Evaluator Vicky Williamson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220609132009
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: 42DATE:
09/02/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrators Cyralynn Mabalot and Myra Palmer TIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff did not treat resident with dignity

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vicky Williamson conducted a complaint visit to deliver findings on the above allegation. LPA was greeted and allowed entry into the facility by Myra Palmer, Administrator. LPA met then Administrators Cyralynn Mabalot and Myra Palmer and discussed the purpose of the visit.

The Department’s investigation consisted of interviews with administrators, clients, outside sources, and review of records to include client records and a police report. It was alleged that staff did not treat resident with dignity. Information received reported that Staff 1 (S1) scolded Client 1 (C1) for smoking and stated if they caught them smoking again, they would withhold their breathing medication. S1 denied the allegation and stated that they told C1, “If you keep smoking, you will always need a nebulizer.” S1 stated that the statement was not meant to be disrespectful. Interview conducted with Administrator Cyralynn Mabalot revealed that she spoke with S1 and C1 regarding S1 threatening to withhold C1’s medication. S1 acknowledged that they stated, “If you keep smoking, you will always need a nebulizer.” C1 advised Administrator Cyralynn that the statement made by S1 made them feel threaten.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
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 5
Control Number 08-AS-20220609132009
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: 09/02/2022
NARRATIVE
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Interview conducted with Administrator Myra Palmer revealed that she was notified by C1 that S1 stated to them, "If you continue to smoke you are not going to get your meds." Administrator Palmer spoke to S1 and they denied making the statement. S1 reported to Administrator Palmer that they stated to C1, “If you continue to smoke, the nebulizer will not work.”

An outside source reported that C1 stated that S1 told them, "If I see you smoking cigarettes, I will not let you use your sleep apnea machine." Per outside source, C1 stated that S1 did not prevent them from using their sleep apnea machine; however C1 stated that a caregiver was notified of the threat.

Interview conducted with C1 did not disclose that S1 did not treat them with dignity. Interviews were conducted with four clients; they denied that staff did not treat them with dignity. C1 and three clients disclosed that staff are nice to them. An interview with Client 5 (C5) revealed that all facility staff can sometimes be mean. C5 stated, "Staff sometimes complains about assisting the clients with their needs." C5 reiterated that although staff complain they do assist the clients with their needs.

The Department has investigated the above-mentioned allegation that staff did not treat resident with dignity. Based on interviews conducted with administrators, staff, clients, outside sources, a police report and S1’s own admission in stating, “If you keep smoking, you will always need a nebulizer,” the preponderance of the evidence standard has been met. Therefore, the allegation is deemed substantiated.



The deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22. A copy of this report along with Licensee/Appeal Rights (LIC 9058) was provided to Administrator Mabalot and the signature on this form confirms receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20220609132009
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: 09/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/16/2022
Section Cited
CCR
80072(a)(3)
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Personal Rights (a)... each client shall have personal rights which include, but are not limited to, the following: (3)To be free from ... humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature... This requirement was not met as evidenced by:
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Administrators will cmplete a training with an outside source for staff and submit proof of training by POC date.
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Based on interviews conducted with administrators, staff, clients, outside sources, review of police report and S1’s own admission in stating, “If you keep smoking, you will always need a nebulizer,” This poses a potential health and safety risk to 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: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/09/2022 and conducted by Evaluator Vicky Williamson
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220609132009

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: 42DATE:
09/02/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrators Cyralynn Mabalot and
Myra Palmer 		TIME COMPLETED:
12:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Vicky Williamson conducted a complaint visit to deliver findings on the above allegation. LPA was greeted and allowed entry into the facility by Myra Palmer, Administrator. LPA then met with Administrators Cyralynn Mabalot and Myra Palmer and discussed the purpose of the visit.

The Department’s investigation consisted of interviews with administrators, clients, outside sources, review of records to include resident records and a police report. It was alleged that staff did not provide medication as prescribed.

It was reported that Staff 1 (S1) withheld Client's (C1) nebulizer and stated, “If you keep smoking, I will not give you your nebulizer.” S1 denied the allegation and stated that they told C1, “If you keep smoking, you will always need a nebulizer.” S1 stated that C1 was provided their medication and that medications are never withheld from any clients. S1 stated that some clients will ask for their medications prior to the time it is scheduled to be given.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20220609132009
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: 09/02/2022
NARRATIVE
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Interviews conducted with Administrator Cyralynn Mabalot revealed that she was not aware of the allegation of medication being withheld from C1. Administrator Mabalot stated, it was reported to her by staff that the El Cajon Police Department reported to the facility on 6/9/22 to follow up on a complaint regarding S1 withholding medication from C1. Administrator Mabalot stated that she spoke with S1 and C1 regarding C1’s medication being withheld. S1 denied not providing C1 their medication; however acknowledged stating “If you keep smoking, you will always need a nebulizer,” C1 advised Administrator Mabalot that S1 provided their medication; however stated that the statement made by S1 made them feel threaten.

Interview conducted with Administrator Myra Palmer revealed that she was notified by C1 that S1 stated to them, "If you continue to smoke you are not going to get your meds." Administrator Palmer spoke to S1 and they denied making the statement and not providing C1 their medication. Administrators Mabalot and Palmar both reported that the Medication Administration Records (MARS) and C1 confirmed that C1's medication was provided to them as prescribed. LPA's review of the facility’s Medication Administration Records confirmed that C1 received their medications as prescribed.

An outside source reported that C1 stated that S1 told them, "If I see you smoking cigarettes, I will not let you use your sleep apnea machine." Per outside source, C1 stated that S1 did not prevent them from using their sleep apnea machine.

Interview conducted with C1 did not disclose that any facility staff withheld their medications from them. Interviews were conducted with four clients; they denied that staff has ever withheld their medication.

Per staff interviews conducted, the clients often ask for their medication prior to the time the medication is to be given. All medications are administered per physicians orders only. If clients are experiencing breathing issues and feel that more medication is needed, 911 would be contacted immediately.

The Department’s investigation found there is insufficient evidence to determine that staff did not provide resident their medication as prescribed. Interviews conducted with the administrators, staff, clients and outside sources provided no conclusive evidence to support the allegation. Based on record review and interviews, allegation is unsubstantiated. Although the allegation may have occurred or is valid, there is not a preponderance of the evidence to prove the alleged violations occurred.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5