374603208-5-19-2022-08-AS-LTEZ-CEYT59-20220601142509

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374603208
Report Date: 05/18/2022
Date Signed: 05/19/2022 11:18:15 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
03/02/2022 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20220302104029

FACILITY NAME:	ALYCHRIS SENIOR BOARD AND CARE		FACILITY NUMBER:	374603208
ADMINISTRATOR:	BANTING, CONSUELO		FACILITY TYPE:	740
ADDRESS:	8536 MENKAR ROAD		TELEPHONE:	(858) 935-9037
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92126
CAPACITY:	6	CENSUS: 6	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Staff, Allan Aganon		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Unlawful Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to conclude the complaint investigation. LPA was greeted and allowed entry into the facility and met with Staff, Allan Aganon. LPA spoke with Licensee, Connie Banting via telephone while at the facility.

During the investigation, LPA toured the facility, and interviewed staff, resident, and outside sources. It was alleged Resident #1 (R1) was unlawfully evicted. On 02/27/22, R1 was transported to the hospital for evaluation. It was reported that when R1 was ready for discharge from the hospital, the licensee refused R1’s return to the facility. Outside source interviews revealed the licensee denied the return of R1 due to R1 needing a higher level of care and the licensee’s hospice waiver would exceed the allotted capacity. Outside source interviews also revealed the hospital was told by the licensee that they would not be accepting R1 back to the facility. Further outside source interviews revealed the hospital did not have any communication with the licensee regarding the refusal of R1’s return to the facility. Therefore, the hospital was not aware the licensee was refusing to accept R1 back to the facility. Continued on an LIS 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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-20220302104029

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: ALYCHRIS SENIOR BOARD AND CARE	FACILITY NUMBER: 374603208
	VISIT DATE: 05/18/2022

NARRATIVE

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Licensee’s interview revealed she did not speak with anyone at the hospital or tell the hospital R1 could not return to the facility. Licensee stated she had a conversation with R1’s responsible party regarding R1’s health and the responsible party ended the call and no further discussion was had. Licensee explained she did not tell R1’s responsible party that R1 could not return and nothing further was discussed due to the call ending. Licensee stated she did not deny the return of R1 to the facility. R1 returned to the facility once discharged from the hospital.

Based on interviews conducted we are unable to confirm or deny if R1 was unlawfully evicted. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. Therefore, the allegation was determined to be unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Staff, Allan Aganon whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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