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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604182
Report Date: 12/09/2022
Date Signed: 12/09/2022 05:17:34 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
02/19/2021 and conducted by Evaluator Dawn Segura
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210219132130
FACILITY NAME:PARADISE TRINITY HOMEFACILITY NUMBER:
374604182
ADMINISTRATOR:JACKSON, LENORE EMILYFACILITY TYPE:
735
ADDRESS:7078 GUNZAN STTELEPHONE:
(619) 434-9284
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:4CENSUS: 4DATE:
12/09/2022
UNANNOUNCEDTIME BEGAN:
11:32 AM
MET WITH:Rayda Alcantara, LicenseeTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Facility did not seek appropriate dental care for resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA introduced herself and was granted entry into the facility by Yolanda Tiangco, Staff, to whom she disclosed the reason for the visit. Licensee, Rayda Alcantara, arrived during the visit.

The Department’s investigation consisted of interviews with staff, outside sources, record review, and a virtual tour of the facility. It was alleged that the licensee did not seek appropriate dental care for Client #1 (C1). Licensee was provided a Confidential Names List in order to identify C1. Record review and interviews revealed that C1, a client with a developmental disability, has resided at the facility since 2012. C1 is non-verbal but is able to express their needs. C1 is assigned a primary dentist who C1 visits every year for a dental check-up. Due to diagnosed disabilities of C1, C1 is unable to undergo dental procedures without sedation. Interviews with staff revealed that because C1 requires sedation, C1 has not had a successful dental visit in the time that he/she has resided at the facility. Interviews with staff and outside sources
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
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 3
Control Number 08-AS-20210219132130
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: PARADISE TRINITY HOME
FACILITY NUMBER: 374604182
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2022
Section Cited
CCR
80075(a)
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Health Related Services. The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. This requirement was not met as evidenced by:
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Licensee stated that a dental visit with sedation for C1 was arranged and was conducted on 10/11/2021. Licensee confirmed that C1 will visit the appropriate dentist for regular check-ups to ensure dental needs are met. Deficiency was cleared during the visit.
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Based upon record review and interviews, the licensee did not ensure that C1 received appropriate dental services. This posed a potential health risk to one of four clients in care.
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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: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20210219132130
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: PARADISE TRINITY HOME
FACILITY NUMBER: 374604182
VISIT DATE: 12/09/2022
NARRATIVE
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revealed that referrals to alternate dentists have been provided to facility staff, but not all referrals have been pursued. Therefore, alternate arrangements with a dentist who is able to provide sedation has not been arranged to assess C1’s dental needs. The Department has investigated the allegation that the licensee did not seek appropriate dental care for C1. Based upon the evidence obtained during the investigation, the preponderance of the evidence standard has been met. Therefore, this allegation is deemed substantiated.

The deficiency is noted on the attached 9099-D and is cited in accordance with the California Code of Regulations, Title 22. An exit interview was conducted with Rayda Alcantara. A copy of this report, along with Licensee Rights (LIC 9058), were provided to the licensee at the conclusion of the visit, and her signature on this report acknowledges receipt of the report and rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3