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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808112
Report Date: 05/31/2023
Date Signed: 05/31/2023 06:25:32 PM

Substantiated


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
08/16/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220816133550
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:
05/31/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Vicmar Manglal Lan, CaregiverTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility did not provide clients with safe environment
Facility maintained in disrepair
INVESTIGATION FINDINGS:
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On 5/31/2023, at about 9:10 AM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced visit to deliver investigative findings on the aforementioned complaint allegations. After introducing himself, presenting his department identification, LPA was granted entry into the facility by Vicmar Manglal Lan, Caregiver to whom the purpose of the visit was discussed. During the visit, LPA briefly toured the facility and conducted interviews.

The Department’s investigation consisted of client, staff, and outside source interviews, record reviews, and direct LPA observation. It was alleged the facility did not provide a safe environment for clients and was maintained in disrepair.

On 8/14/2022, a person, to whom Client 1 (C1) was familiar with, struck C1 in the head and face with an object resembling a cane. Investigation revealed that this person did not reside at the facility but was a former client. It was also learned that this person is involved in some type of relationship with C1. Law
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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 6
Control Number 08-AS-20220816133550
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: 05/31/2023
NARRATIVE
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enforcement was summoned and responded to the facility. Upon their investigation, it was determined the suspect had assaulted the client. Officers removed the person from the facility and transported them to a hospital for evaluation. Outside agency source records confirmed the outside party struck the victim/client with a cane. No injuries were observed by staff nor outside agencies.

As part of this investigation, interviews were conducted with staff as well as C1. The staff indicated that the two parties have had ongoing issues for several years. C1 was interviewed and stated that they get into confrontations with this person all the time both on facility grounds and offsite. C1 said, the arguments at times escalated into physical assault by the outside party. When asked why they did not obtain a restraining order against the person, C1 said they loved the person. C1 wants to be able to see the person off facility grounds. C1 wants the facility to get a restraining order, so it can be C1’s “safe place.”

Interviews revealed that facility administrators were advised by law enforcement to obtain a restraining order prohibiting the person from entering the facility property. During one administrator’s interview, they were asked why the facility did not attempt to get a restraining order to keep the outside party off facility property. The administrator said this issue had come up before, but management said the facility could not obtain a restraining order.

It was also reported that the facility was in disrepair. During this investigation, LPA toured the facility inside and out. LPA noticed that clients smoke cigarettes inside and outside of their rooms, as there was a strong odor of cigarette smoke prominent throughout the facility. LPA observed C1 and their roommate in their assigned room. The common areas and client rooms were dilapidated, smelled strongly of cigarette smoke and many of the floor tiles were cracked.

LPA also observed what appeared to be an air conditioning unit in C1's bathtub. The unit was not plugged in, and the electrical cord was lying on the bathroom tile floor. LPA noticed C1's sink basin and countertop were stained and had a cigarette burn and crack on the counter top. The tile grout was dark brown and appeared to be stained. C1's room was organized and kempt, but LPA observed chipping paint on the upper wall and ceiling. LPA also observed cracked tile on C1’s room floor.

LPA interviewed administrators and informed them of what was observed during the complaint inspection in August 2022. When asked, staff acknowledged the facility is old and requires ongoing repairs throughout
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 08-AS-20220816133550
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: 05/31/2023
NARRATIVE
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the facility. Maintenance staff was interviewed, and they advised that they have made numerous positive changes which LPA also observed. Maintenance staff mostly has fixed and painted numerous walls throughout the facility. Facility administrators do not use a work order system but rather advise maintenance staff what needs to be fixed on any given day.

Based on LPA observation, statements from staff, clients and outside sources, and review of facility and outside source records, there is sufficient evidence to prove the facility did not provide a safe environment for clients. Additionally, sufficient evidence also proves the facility is in disrepair. As such, the preponderance of evidence standard was met. Therefore, the allegations are Substantiated. A deficiency is cited per Title 22 California Code of Regulation.

LPA conducted an exit interview with Myra Palmer, Administrator, to whom a copy of this report, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided and whose signature below confirms receipt of the reports.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 08-AS-20220816133550
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/02/2023
Section Cited
CCR
80072(a)(2)
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Each client shall have personal rights which include, but are not limited to, the following: to be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment to meet his/her needs. This requirement was not met as evidenced by:
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The Licensee will contract for vendorized training for 100% staff regarding client Personal Rights. Licensee will submit written verification of contract to CCLD by POC due date of June 1, 2023. Licensee will also submit written proof of completed staff training to CCLD by June 30, 2023.
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Based on interviews and record reviews, the facility did not accord safe and healthful accommodations to clients in care. This posed an immediate risk to 1 of 42 clients.
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Type B
06/14/2023
Section Cited
CCR
85087
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Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees, and visitors. This requirement was not met as evidenced by:


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Facility will prepare and implement a maintenance priority list and submit weekly updates to CCLD with photographs. The maintenance priority list will be submitted to CCLD by the POC date of June 14, 2023.

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Based on observations and interviews, the licensee did not ensure the facility was in good repair which posed a potential health, safety, and personal rights risk to 42 of 42 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.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
08/16/2022 and conducted by Evaluator Daniel Pena
COMPLAINT CONTROL NUMBER: 08-AS-20220816133550

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:
05/31/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Vicmar Manglal Lan, CaregiverTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff allowed clients access to illegal drugs
Facility did not provide planned activities
INVESTIGATION FINDINGS:
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It was also alleged; staff allowed client’s access to illegal drugs and do not provide planned activities.
During an interview with an outside source, it was reported that an acquaintance of a client, who was also a former client, has been providing drugs to clients at the facility. This source indicated that the information is about two years old, and the source has never personally witnessed the activity. The source did not know if the activity was still occurring. Interviews with staff members and clients state they heard the former client provided drugs to clients several years ago when they lived at the facility. However, none of the persons interviewed witnessed the activity themselves.

During interviews with staff and clients, they indicated that some clients leave the facility property to use illegal drugs. These parties have not seen any clients use or possess illegal drugs on facility property due to the potential of being evicted from the facility. According to staff, drugs including Marijuana are prohibited at the facility. Although Marijuana is now legal, it is still prohibited on the property. If a client is caught with Marijuana, they get a warning the first time. If caught a second time, the client will be served with a 30-day eviction notice.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 08-AS-20220816133550
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: 05/31/2023
NARRATIVE
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It was also alleged that the facility does not provide planned activities to clients. Clients and outside sources state that clients do nothing but sit around and watch television. While inspecting the facility, LPA noticed several clients sitting on chairs outside, smoking cigarettes. LPA noted some clients were inside common areas watching television. No programming or activities were occurring at time of LPA's visit.

LPA asked staff if the facility offers clients any programs or activities. Staff said that it does. They offer "house rules" activities, staying sober, anger management, trips to the 99-cent store, board games and physical exercise. Staff said facility staff facilitate the programs and activities to the clients themselves.

During this investigation, LPA obtained and reviewed a copy of the activity calendar for August 2022 which listed various activities and programs occurring on most days of the month. LPA also obtained copies of client sign in sheets which indicated client participation.

Based on interviews with clients and staff, this investigation yielded no evidence to support the allegation that staff allows clients access to illegal drugs. Additionally, based on interviews and facility record reviews, there is insufficient evidence to prove the allegation that the facility does not provide clients with planned activities. As such, the preponderance of evidence standard was not met for these allegations. As such, the allegations are Unsubstantiated.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6