374602052-12-15-2022-08-AS-JRAE-CMKUCA-20221229142735

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602052
Report Date: 12/15/2022
Date Signed: 12/15/2022 09:51:30 AM

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
05/05/2022 and conducted by Evaluator Iby Strong

COMPLAINT CONTROL NUMBER: 08-AS-20220505113759

FACILITY NAME:	OLIVENHAIN GUEST HOME		FACILITY NUMBER:	374602052
ADMINISTRATOR:	KAREN KANAN		FACILITY TYPE:	740
ADDRESS:	350 COLE RANCH ROAD		TELEPHONE:	(760) 753-5082
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	0	CENSUS: 0	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Report Mailed to Licensee via USPS Certified Mail		TIME COMPLETED:	09:33 AM

ALLEGATION(S):

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Staff did not safeguard resident's belongings.
Facility telephone is not working.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong sent this report to the former licensee's last known mailing address via USPS certified mail to deliver the investigation findings for the above-mentioned allegations. This facility ceased operations on September 23, 2022.

On May 5th, 2022, Community Care Licensing (CCL) received a complaint alleging facility staff did not safeguard resident’s belonging and facility telephone is not working.

During investigation, LPA Strong conducted interviews and collected pertinent resident records. It was alleged that on or about May 2022, staff did not safeguard resident’s dog food resulting in theft. An outside source interview revealed that food for resident’s service dog is maintained by the outside source. The outside source explained that the dog food is not missing, and all items are and have been accounted for. Interview with administrator revealed that no reports of missing items have been received during this timeframe.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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-20220505113759

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: OLIVENHAIN GUEST HOME	FACILITY NUMBER: 374602052
	VISIT DATE: 12/15/2022

NARRATIVE

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Additionally, it was alleged that the telephone for the facility was dropping calls and not in service. During LPA Strong’s facility inspection on May 10^th, 2022, LPA made calls to the facility phone and verified its functionality. During the inspection, there were no issues found with the telephone. Interview with the administrator revealed that the phone company had maintenance on telephone lines, making the main facility telephone unavailable. Interview with administrator also revealed that when telephone service was down, calls were forwarded to administrator phone. LPA Strong verified this information with data report from telephone company and call forwarding statement.

Based on LPA's outside source interviews, observations and record reviews there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegations are unsubstantiated. A copy of this report and Licensee/Appeals Rights (LIC 9058) were sent to the licensee's last known address via USPS certified mail due to facility closure.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

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