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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808112
Report Date: 02/09/2023
Date Signed: 02/09/2023 02:14:28 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
06/14/2021 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20210614111035
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: 41DATE:
02/09/2023
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Administrator, Myra PalmerTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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-Staff is impaired by the use of alcohol on the job.
-Staff does not assist clients when they request help.
INVESTIGATION FINDINGS:
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On February 10, 2023, at about 10:52 AM, Licensing Program Analyst (LPA) Daniel Pena conducted a complaint investigation visit to deliver findings regarding the above-mentioned allegations. LPA was greeted at the entrance by Administrator, Myra Palmer and granted entry after identifying himself and disclosing the reason for the visit.

It was alleged staff is impaired by the use of alcohol while on the job. This investigation consisted of physical plant visits, record reviews and interviews with clients and staff.

The investigation revealed that the accused employee is not responsible for client care and supervision. The employee performs tasks in support of facility operations. Additionally, it was revealed during the investigation that facility management provides a small living space to the employee. The area is not accessible to clients. Interviews did not bring forth corroborating information that any employee is impaired by alcohol. Employee records were reviewed, and nothing was obtained to support the allegations.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
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-20210614111035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: FANCOR GUEST HOME
FACILITY NUMBER: 370808112
VISIT DATE: 02/09/2023
NARRATIVE
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The Department has investigated the allegations staff is impaired by the use of alcohol while on the job and does not assist clients when they request it. Based on interviews and record reviews, the findings are determined to be Unsubstantiated. These findings mean although the allegations may have occurred or could be valid, there is not a preponderance of evidence to prove the alleged violations occurred.

An exit interview was conducted with Administrator, Palmer. A copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) were provided and Administrator, Palmer signature on this form confirms receipt of these reports.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2