374603092-1-24-2021-08-AS-DPOL-BYLL3M-20210226072409

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603092
Report Date: 01/24/2021
Date Signed: 01/24/2021 11:44:49 AM

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
03/03/2020 and conducted by Evaluator Evangelica Torres

COMPLAINT CONTROL NUMBER: 08-AS-20200303143656

FACILITY NAME:	WHITE ORCHID GUEST HOME		FACILITY NUMBER:	374603092
ADMINISTRATOR:	ESTEPA, STAN		FACILITY TYPE:	740
ADDRESS:	978 WEST 2ND AVE		TELEPHONE:	(760) 737-6030
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92025
CAPACITY:	5	CENSUS: 3	DATE:	01/24/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Stan Estepa		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Licensee violated Resident #1's personal rights.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Eva Torres conducted a virtual visit via Zoom to deliver findings on the above allegation due to COVID-19. LPA identified herself, spoke with Administrator, Stan Estepa and disclosed the purpose of the phone call. The investigation included a review of records and interviews conducted. It was alleged that the licensee violated Resident's #1 (See LIC 811- Confidential Names List for R1) personal rights by inappropriately raising their voice towards them. On 03/03/20, at approximately 08:00 AM, an essential visitor (EV1) conducted a routine unannounced visit. While EV1 was waiting for a response at the front entrance, they overheard a male voice communicating in a loud and frustrating manner inside the facility. When the male staff answered the front door, EV1 identified themselves, and stated that the purpose of their visit was to provide additional care support for R1. However, the male staff denied EV1 entry and asked them to come at a later time. On 03/05/20, at approximately 12:00 PM, EV1 made a second unannounced visit. At that time, they were granted entry into the facility. EV1 met with R1 and initiated care assistance by preparing the temperature of the water in the bathroom. However, the water continued to run cold. EV1 asked the administrator about the water’s temperature and the administrator replied was that the water heater had to be turned back on.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2021

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-20200303143656

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: WHITE ORCHID GUEST HOME	FACILITY NUMBER: 374603092
	VISIT DATE: 01/24/2021

NARRATIVE

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Also, a review of outside source’s records confirmed that the above chain of events occurred, as the visitor’s observations were documented in an ongoing logbook. Moreover, interviews conducted with outside sources, residents, and their responsible parties produced evidence that the administrator was witnessed inappropriately raising their voice towards the residents, as well as confirmed that hot water was not always available for residents in care. Based on the records reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), a deficiency is being cited on the attached LIC 9099D. A virtual exit interview was conducted with Administrator, Stan Estepa, and Licensee/Appeal Rights (LIC 9058 01/16) along with a copy of this report was provided to the administrator via email. A return email from the administrator will confirm receipt of documents.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2021

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200303143656

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: WHITE ORCHID GUEST HOME	FACILITY NUMBER: 374603092
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/05/2021 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met by:	1 2 3 4 5 6 7	Administrator stated that they will review the section that they were cited under and develop a plan to ensure that resident's rights are understood and respected.
	8 9 10 11 12 13 14	Based on interviews conducted and records reviewed, the facility violated resident’s personal rights by raising their voice in an inappropriate manner towards them. This act poses a potential mental health risk to the resident in care.	8 9 10 11 12 13 14	The administrator informed the LPA that they will forward their plan by the POC due date of 02/05/21.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Denise Powell	TELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica Torres	TELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2021

LIC9099 (FAS) - (06/04)

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