<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602902
Report Date: 01/22/2025
Date Signed: 01/22/2025 04:44:47 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
01/16/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250116133040
FACILITY NAME:LYN'S HOME CARE IIIFACILITY NUMBER:
374602902
ADMINISTRATOR:ABILLE, LYDIAFACILITY TYPE:
735
ADDRESS:186 MOSS STTELEPHONE:
(619) 426-2804
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:6CENSUS: 4DATE:
01/22/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee Lydia “Lyn” AbilleTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
-Licensee did not give client medication as prescribed.
-Licensee’s staff did not exhibit skill/knowledge related to medication assistance.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Lydia “Lyn” Abille.

The Complainant alleged that Licensee did not give Client #1 (C1) medication as prescribed, and that Licensee’s staff, Staff #1 (S1), did not exhibit skill/knowledge related to medication assistance. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check on clients in care, an inspection of C1’s medication inventory at the facility, and a review of pertinent care and personnel records. The Department also interviewed C1, all housemates who were present, and relevant facility staff and outside sources.

[CONTINUED ON LIC 9099-C, 1 of 2]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
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 4
Control Number 08-AS-20250116133040
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: LYN'S HOME CARE III
FACILITY NUMBER: 374602902
VISIT DATE: 01/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
[CONTINUED FROM LIC 9099]

Records and interviews showed: C1 was diagnosed with Schizophrenia and relied on assistance from facility staff to store and take their prescribed medications. C1 had three (3) prescription medications [i.e., Medication A, Medication B, and Medication C] that they were supposed to take in the evening/bedtime, every day. During the evening of 01/15/2025, Staff #1 (S1) had sole responsibility for handing the clients' their medicine pills/tablets. Due to themselves being confused, S1 did not give C1 their three (3) prescribed evening/bedtime medications on that date. S1’s error did not affect the other clients in care on that date. CCLD also did not find evidence of C1 not receiving their medications on other dates.

According to C1’s medication list and supplemented by academic review: Medication A was an antipsychotic drug prescribed to treat C1’s Schizophrenia. Medication B was an antispasmodic drug prescribed to mitigate side effects of Medication A, which were related to C1’s muscle control and normal movements of the body. Medication C was prescribed to treat C1’s tachycardia (i.e., a condition where the heart beats abnormally fast). Per interview of C1 themselves: After missing their evening/bedtime doses of Medications A, B, and C on 01/15/2025, they experienced increased anxiety, had impaired motor control over their own tongue, and were compulsively shaking their own hands and opening and closing their fists. Their symptoms lasted less than 24 hours, and were resolved upon their receiving Medications A, B, and C, the following day. C1 did not require outside medical treatment for these adverse symptoms.

During the 01/15/2025 incident, S1 had direct key access to C1’s medication records and prescription labels, which they could have used to resolve their confusion. However, S1 did not attempt to consult these resources. S1 also did not summon/contact the Licensee (who was onsite but asleep at the time) for help. Interviews of S1 and Licensee aligned to show: S1 fully relied on Licensee to dispense clients’ pills/tablets from their labeled blister packs (i.e., the packages in which the pills/tablets arrive from the pharmacy) in advance. S1 was then responsible for independently handing the dispensed pills to clients in care, at a subsequent time. Although S1 did not personally remove the pills from the blister packs, S1 remained significantly engaged in assisting clients with self-administration of medications. Licensee had not trained S1 on “assistance with prescribed medications which are self-administered…as appropriate for the job assigned and as evidenced by safe and effective job performance,” as was required by regulation.

[CONTINUED FROM LIC 9099-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250116133040
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: LYN'S HOME CARE III
FACILITY NUMBER: 374602902
VISIT DATE: 01/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
[CONTINUED FROM LIC 9099-C, 1 of 2]

Based on records and interviews, a preponderance of evidence exists to show that on 01/15/2025, Licensee did not give Client #1 (C1) medication as prescribed, and that Licensee’s staff, Staff #1 (S1), did not exhibit skill/knowledge related to medication assistance. Both allegations are therefore Substantiated. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). Since one of the violations contributed to exacerbation of illness for C1, an Immediate Civil Penalty of $500 was also charged/assessed to Licensee (refer to the LIC421-IM page). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Lydia “Lyn” Abille, to whom a copy of this report, the LIC 9099-D page, the LIC421-IM page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250116133040
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: LYN'S HOME CARE III
FACILITY NUMBER: 374602902
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/22/2025
Section Cited
CCR
80075(b)
1
2
3
4
5
6
7
80075 Health Related Services: “(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.” This requirement was not met, as evidenced by:
1
2
3
4
5
6
7
As of the date of deficiency issuance: C1 has resumed taking their medications as prescribed, their adverse symptoms have subsided, their case management agency and prescribing physician are aware of the incident, and Licensee has notified CCLD in writing about the incident. These actions resolved the immediate risk, and the Plan of Correction is Satisfied. Licensee agreed to have S1 undergo an eight (8) hour formal medication training class, taught by a nurse from their contracted pharmacy, and to submit proof of training completion to LPA, by 02/22/2025.
8
9
10
11
12
13
14
Based on records and interviews, Licensee did not ensure that 1 of 4 clients (C1) was assisted as needed with self-administration of prescription medications. This posed an immediate health risk to persons in care.
8
9
10
11
12
13
14
Type B
02/22/2025
Section Cited
CCR
80065(f)(4)
1
2
3
4
5
6
7
80065 Personnel Requirements: “(f) All personnel shall be given on-the-job training or shall have related experience which provides knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (4) Assistance with prescribed medications which are self-administered.” This requirement was not met, as evidenced by:
1
2
3
4
5
6
7
Licensee agreed to have S1 undergo an eight (8) hour formal medication training class, taught by a nurse from their contracted pharmacy, and to submit proof of training completion to LPA, by the POC due date.
8
9
10
11
12
13
14
Based on records and interviews, Licensee did not ensure that 1 of 4 staff (S1) had training/experience, as appropriate to the job assigned and as evidenced by safe and effective job performance, in assisting clients with prescribed medications which are self-administered. This posed a potential health risk to 4 of 4 clients [C1 through Client #4 (C4)] in care.
8
9
10
11
12
13
14
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: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4