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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604270
Report Date: 12/12/2024
Date Signed: 12/12/2024 04:53:50 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
12/09/2024 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20241209085748
FACILITY NAME:ALLIANCE GUEST HOMEFACILITY NUMBER:
374604270
ADMINISTRATOR:CHONG, CANDYFACILITY TYPE:
735
ADDRESS:1525 OLEANDER AVENUETELEPHONE:
(619) 349-3204
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY:4CENSUS: 3DATE:
12/12/2024
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lead Caregiver Elizabeth De Guia and Administrator Henrietta “Candy” ChongTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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-Absence of Client Supervision
-Licensee did not ensure medications were secured.
-Licensee did not ensure confidential client records were secured.
-Licensee did not meet storage requirements for perishable food.
INVESTIGATION FINDINGS:
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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 Lead Caregiver Elizabeth De Guia. LPA also met with Administrator Henrietta “Candy” Chong, who arrived later during the visit.

The Complainant alleged that on 11-27-2024, there was an Absence of Client Supervision on the part of Licensee, in that Client #1 (C1) was briefly alone at the facility without facility staff present. [See LIC 811 Confidential Names List for a description of select person identifiers used in this report.] They also alleged that Licensee did not ensure that medications and confidential client records were secured, and that Licensee did not meet storage requirements for perishable food. CCLD’s investigation involved an unannounced facility tour / welfare check and review of pertinent care records and San Diego Regional Center (SDRC) records. LPA also interviewed C1 and relevant facility staff and an outside source. [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: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
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 5
Control Number 08-AS-20241209085748
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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
VISIT DATE: 12/12/2024
NARRATIVE
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[CONTINUED FROM LIC 9099]

According to their latest LIC602 Physician’s Report, C1 was diagnosed with Mild Intellectual Disability and Schizophrenia, and their doctor determined that C1 required staff assistance to safely store and take their medications. Per facility and SDRC care records and staff interviews, C1 did not have any recent problems with aggressive or self-injurious behaviors. LPA observed that C1 was alert, aware, and oriented, and able to be qualified as a witness for this case.

SDRC records, and staff and outside source interviews, closely aligned to show: On the afternoon of 11-27-2024, Staff #1 (S1) was supposed to be at the facility to receive C1 as they came home from their day program. However, S1 had earlier left to run an errand, and they did not make it back to the facility on time. S1 did not notify Licensee that they were running late. C1 was dropped off at the facility by the day program transportation, and C1 then entered the facility using a coded-entry access via the garage. C1 was indeed at the facility without any facility staff present; the period in question did not exceed 30 minutes. [The other two clients of the facility, Client #2 (C2) and Client #3 (C3), were still at their respective day programs during this incident and were not affected by it.]

During this time, S1’s set of facility keys were left atop of a cabinet about five feet in height (which C1 was tall enough to see and reach). During today’s visit, LPA observation, confirmed by staff interviews, showed the keys in question corresponded to cabinets at the facility, which contained, in part: Confidential records for 3 of 3 clients, medications for 3 of 3 clients, and other medications pending destruction. During the incident, these cabinets themselves were locked, but S1 keys to said locks were unsecured. Also, earlier around 7:00 AM on 11-27-2024, S1 had prepared a food dish containing chicken and pork. S1 left this dish in a pan atop a stovetop which was turned off, for around seven (7) hours, instead of storing it in the refrigerator.

Per interview of C1, during the time they were alone at the facility: No harm or injury befell C1. C1 could have accessed S1’s keys, but they did not pay attention to C1’s keys nor attempt to open any of the cabinets in question. C1 could have accessed the food in question, but they did not try to eat it. (Said food was not served to clients).

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

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20241209085748
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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
VISIT DATE: 12/12/2024
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 2]

Records and interviews showed that after the incident, and prior to CCLD receiving the complaint: Licensee had already individually counseled S1 regarding the incident and provided formal remedial training to S1 on their job duties (to include supervision of clients, required communication with management, and securing records/medications/hazardous items) and safe food handling/storage requirements. LPA interview of S1 showed they comprehended the lessons learned.

Based on records and interviews, a preponderance of evidence exists to show that there was indeed a period of Absence of Client Supervision on the part of Licensee, that Licensee did not ensure medications were secured, that Licensee did not ensure that confidential client records were secured, and that Licensee did not meet storage requirements for perishable food.

The four (4) allegations were therefore Substantiated. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D pages). Since one of the violations was Absence of Supervision, an immediate civil penalty of $500.00 was also charged, and is noted on the LIC421-IM page. Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Chong and De Guia. A copy of this report, the LIC 9099-D pages, the LIC421-IM page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during today’s visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20241209085748
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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2024
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision: “(a) The licensee shall provide care and supervision as necessary to meet the client's needs.” This requirement was not met, as evidenced by:
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Records and interviews showed Licensee already individually counseled S1 regarding the incident and provided formal remedial training to S1 on their job duties (to include supervision of clients and required communication with Licensee). LPA interview of S1 showed they comprehended the lessons learned. The Plan of Correction is thus Satisfied.
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Based on records and interviews, during the incident in question, Licensee did not provide care and supervision necessary to meet the needs of 1 of 3 clients (C1), which posed an immediate health, safety, and personal rights risk to persons in care.
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Type B
12/12/2024
Section Cited
CCR
80075(k)(1)
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80075 Health Related Services: “(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.” This requirement was not met, as evidenced by:
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Records and interviews showed Licensee already individually counseled S1 regarding the incident and provided formal remedial training to S1 on their job duties (to include securing their keys and medications). LPA interview of S1 showed they comprehended the lessons learned. The Plan of Correction is thus Satisfied.
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Based on records and interviews, during the incident in question, Licensee did not ensure medications were stored inaccessible to persons other than employees responsible for the supervision of the centrally stored medication. This posed a potential health and safety risk to 1 of 3 clients (C1) 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: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20241209085748
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: ALLIANCE GUEST HOME
FACILITY NUMBER: 374604270
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2024
Section Cited
CCR
80070(c)(1)
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80070 Client Records: “(c) All information and records obtained from or regarding clients shall be confidential. (1) The licensee shall be responsible for safeguarding the confidentiality of record contents.” This requirement was not met, as evidenced by:
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Records and interviews showed Licensee already individually counseled S1 regarding the incident and provided formal remedial training to S1 on their job duties (to include securing their keys and centrally-stored medications). LPA interview of S1 showed they comprehended the lessons learned. The Plan of Correction is thus Satisfied.
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Based on records and interviews, during the incident in question, Licensee did not safeguard the confidentiality of client records. This posed a potential personal rights risk to 3 of 3 clients (C1 through C3) in care.
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Type B
12/12/2024
Section Cited
CCR
80076(a)(14)
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80076 Food Services: “(a) In facilities providing meals to clients, the following shall apply: (14) All foods or beverages capable of supporting rapid and progressive growth of microorganisms which can cause food infections or food intoxications shall be stored in covered containers at 45 degrees F…or less.” This requirement was not met, as evidenced by:
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The food in question was not served to clients. Records and interviews showed Licensee already individually counseled S1 regarding the incident and provided formal remedial training to S1 on their job duties, to include safe food handling and storage. LPA interview of S1 showed they comprehended the lessons learned. The Plan of Correction is thus Satisfied.
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Based on records and interviews, during the incident in question, Licensee did not ensure that food, which was capable of supporting rapid and progressive grown of microorganisms which can cause food infection or food intoxication, was stored in a covered container at 45 degrees F or less. This posed a potential health risk to 1 of 3 clients (C1) 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: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5