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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370808534
Report Date: 02/03/2023
Date Signed: 02/03/2023 01:19:35 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
02/01/2023 and conducted by Evaluator Elizabeth Hamilton
COMPLAINT CONTROL NUMBER: 08-AS-20230201160309
FACILITY NAME:GUILAS BOARD AND CARE HOMEFACILITY NUMBER:
370808534
ADMINISTRATOR:MA. ELENA GUILASFACILITY TYPE:
735
ADDRESS:1185 NACION AVENUETELEPHONE:
(619) 565-2797
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 6DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee, Elena Guilas TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff did not sign client's Medication Administration Record
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced complaint investigation at the facility for the above allegation. LPA was greeted at the front entrance by Caregiver, Arminda Flores, identified herself and was granted entry into the facility. Licensee, Elena Guilas arrived during the visit. LPA Hamilton explained the purpose of the visit and the elements of the complaint.

The Department’s investigation consisted of client records reviewed, interviewed staff and outside sources and a brief tour the facility.

On February 01, 2023, it was alleged that the facility staff did not sign client’s Medication Administration Record (MAR). Outside source interviews corroborated the MAR for client 1 (C1 See LIC 811 - Confidential Names List) was not completed for December 01, 2022, through December 29, 2022. Outside source and staff interviews and records reviewed and confirmed the medication was administered; however, it was not documented.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
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 3
Control Number 08-AS-20230201160309
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: GUILAS BOARD AND CARE HOME
FACILITY NUMBER: 370808534
VISIT DATE: 02/03/2023
NARRATIVE
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On February 3, 2023, LPA observed the MAR for C1 and confirmed the MAR was updated and corrected for the dates in question. Interviews with staff confirmed the MAR for C1 was not updated until December 29, 2022.

The Department has investigated the allegation of facility staff did not sign client’s Medication Administration Record. Based on evidence obtained, the allegation is substantiated which means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited in accordance of California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the 9099D.

An exit interview was conducted with Licensee, Guilas and a copy of this report, LIC 9099D and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230201160309
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: GUILAS BOARD AND CARE HOME
FACILITY NUMBER: 370808534
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
80070(a)
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80070(a) Client Records. The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement was not met as evidenced by:
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Licensee provided a copy of Medication Management Training that took place on January 13, 2023 to the department. POC Cleared.
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Based on interviews and records reviewed, the facility staff did not record each dose in the medication administration records for C1 which posed a potential health risk to 1 of 6 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: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3