370808112-4-24-2024-08-AS-LTEZ-D4TUZR-20240430160158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370808112
Report Date: 04/24/2024
Date Signed: 04/24/2024 11:42:10 AM

Unsubstantiated

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
11/03/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20231103115649

FACILITY NAME:	FANCOR GUEST HOME		FACILITY NUMBER:	370808112
ADMINISTRATOR:	HUERTAS, FANNIE		FACILITY TYPE:	735
ADDRESS:	631-651 TAFT AVENUE		TELEPHONE:	(619) 588-1761
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	44	CENSUS: 43	DATE:	04/24/2024
		UNANNOUNCED	TIME BEGAN:	11:38 AM
MET WITH:	Myra Palmer, Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff did not obtain emergent medical treatment
Staff did not administer resident's medications as prescribed.
Staff did not notify authorized representative of incident.
Staff did not safeguard resident's personal belongings.
Facility has pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Myra Palmer, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Administrator.

On November 3, 2023, a complaint was received regarding multiple allegations at Fancor Guest Home. The allegations included the following: Facility staff did not obtain emergent medical treatment, staff did not administer residents medications as prescribed, staff did not notify authorized representative of incident, staff did not safeguard resident's personal belongings, and facility has pests.

Upon receiving the complaint, an investigation was conducted by the Department to determine the validity of the allegations. The investigation included interviews with staff members, residents, outside sources, and family members, as well as a tour of the facility.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20231103115649

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: FANCOR GUEST HOME	FACILITY NUMBER: 370808112
	VISIT DATE: 04/24/2024

NARRATIVE

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After a review of the records, it was determined that the allegations were unsubstantiated. The investigation found that facility staff did follow proper protocols in obtaining emergent medical treatment for Resident 1 (R1). Additionally, staff were found to be administering medications as prescribed and that R1 was compliant in taking medications. Facility staff also followed protocols and notified R1's responsible party who then notified the family of the incident.

Furthermore, it was confirmed that staff did take appropriate measures to safeguard residents' personal belongings and family picked up R1's belonging at 6:58 pm on October 29, 2023, and that the facility addressed any issues of pests through regular pest control measures last date of inspection was on October 9, 2023 and there were no active pests issues found.

Based on the findings of the investigation, it is determined that the allegations against Fancor Guest Home: Facility staff did not obtain emergent medical treatment for a resident in need. Staff did not administer residents medications as prescribed. Staff did not notify the authorized representative of the resident of the incident.

Staff did not safeguard the resident's personal belongings and the facility has pests are unsubstantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to Myra Palmer, Administrator. Her signature on this form confirms receipt of the documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC9099 (FAS) - (06/04)

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