374601166-3-18-2023-08-AS-SJAB-CQBUBR-20230327152643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601166
Report Date: 03/17/2023
Date Signed: 03/18/2023 12:50:54 PM

Unsubstantiated

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
03/01/2023 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20230301110752

FACILITY NAME:	ANTHONY GUEST HOME		FACILITY NUMBER:	374601166
ADMINISTRATOR:	ANTONIO C. BALANZA		FACILITY TYPE:	735
ADDRESS:	14435 HIGH PINE STREET		TELEPHONE:	(858) 748-3669
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	6	CENSUS: 5	DATE:	03/17/2023
		UNANNOUNCED	TIME BEGAN:	05:35 PM
MET WITH:	Caregiver Adonay		TIME COMPLETED:	06:20 PM

ALLEGATION(S):

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Staff restrained client.
Staff did not provide quality food to clients.
Licensee did not follow food storage requirements.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegations. LPA Correia met with Caregiver Adonay to whom was explained the purpose for the visit.

The Department’s investigation consisted of staff, client, and outside source interviews, a facility records review, and a facility tour.

It was alleged facility staff restrained a client in care. An Outside Source1 (OS1) (see LIC 811 for confidential names list) interview revealed facility staff locked Client1 (C1) in their room when C1 would become aggressive and break property at the facility. Interviews conducted with facility staff corroborated C1 would break property at the facility when having a behavior, however denied ever locking C1 in their bedroom. Interviews conducted with all but one (1) client (Client2 (C2)), revealed staff never locked C1 in their room. An interview conducted with C2 stated staff does lock C1 in their room. C2 also revealed C1 does not know how to unlock the door and will knock on the door when they wanted out. An interview with Client3 (C3) revealed sometimes when C1 had a behavior C1 locked themselves in their room and would knock on their bedroom walls/door and facility staff would come and unlock C1's door to check on and redirect C1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

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-20230301110752

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: ANTHONY GUEST HOME	FACILITY NUMBER: 374601166
	VISIT DATE: 03/17/2023

NARRATIVE

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LPA, accompanied by C1, observed C1's bedroom door and secured a photo. LPA observed the door can only be locked from inside C1's bedroom by pushing a button centered in the doorknob. LPA asked C1 to lock the door, and C1 proceeded to shut the door and then pressed the button and locked the door. LPA then asked C1 to unlock and open the door, C1 then turned the doorknob, which automatically unlocked the door, and opened the door with ease. LPA observed C1's bedroom doorknob facing the facility hallway and observed had a small hole that allowed staff to unlock the door utilizing a small device that is inserted into the hole to unlock the door in the case C1 locked themselves in their room.

It was also alleged staff did not provide quality food to clients. An interview conducted with an Outside Source (OS1) revealed staff did not provide substantial meals to clients in care. Interviews conducted with clients revealed staff provided meals and snacks, and clients felt well fed. Client interviews also revealed staff had made a pasta dish the day of the visit on March 9, 2023. An interview with facility staff corroborated clients had pasta earlier that day and revealed staff made a variety of different meals for the clients in care. LPA secured and reviewed the facility menu for the month of March 2023 which revealed three (3) meals and two (2) snacks were planned for the entire month. A tour of the facility kitchen revealed a sufficient amount of food per Title 22 mandate.

It was also alleged facility staff did not follow food storage requirement. An interview conducted with an Outside Source (OS1) revealed clients were not able to access food because facility staff locked the kitchen cabinets. LPA conducted a tour of the kitchen and observed that the only cabinet doors with locks were on cabinets that contained toxins and hazards such as cleaning supplies and knives. LPA observed the cabinets containing food were all accessible to clients in care. Interviews with staff and clients both revealed food was not kept locked at the facility.

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

LPA Correia conducted an exit interview with Caregiver Adonay. At the time of the exit interview Caregiver Adonay was advised a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided and signature on this report acknowledges receipt of the rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023

LIC9099 (FAS) - (06/04)

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