374604434-9-7-2023-08-AS-DNGN-CVG2U8-20230907174156

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604434
Report Date: 09/07/2023
Date Signed: 09/07/2023 05:42:27 PM

Document Has Been Signed on 09/07/2023 05:42 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	GALINDO HOME CARE INC.		FACILITY NUMBER:	374604434
ADMINISTRATOR:	TORRES, ERNESTINA		FACILITY TYPE:	735
ADDRESS:	3447 LAS VEGAS DR		TELEPHONE:	(442) 266-2914
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY: 3		CENSUS: 3	DATE:	09/07/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Co-Administrator Princess Torres		TIME COMPLETED:	06:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Co-Administrator Princess Torres.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 09/02/2023). According to the LIC624: during an 09/01/2023 community outing with staff, Client #1 (C1) eloped / went AWOL (meaning they left staff supervision). [See LIC 811 Confidential Names List for a description of C1.] Later that same evening, C1 was located and returned to the facility uninjured/unharmed.

During today’s visit, LPA performed a facility tour and welfare check on C1, verifying that they were indeed unharmed. LPA also reviewed pertinent care records and interviewed relevant staff.

According to their LIC602 Physician’s Report (dated 06/22/2023), C1’s diagnoses included “Autism Spectrum Disorder.” To the stock question of whether C1 was “at risk if allowed to leave the community unsupervised,” the physician made no comment (they left that field blank). However, C1’s Client Placement Referral (dated 05/02/2023) from San Diego Regional Center (SDRC) indicated that C1 had “been struggling with mental health,” had a recent suicide attempt, and required “more supervision to ensure [their] safety.” Multiple staff interviews corroborated that C1 required staff supervision when outside of the facility.

According to the facility’s written Absentee Notification Plan: if a client is suspected to be missing, staff are required to notify the client’s “authorized representative” within one (1) hour and law enforcement within two (2) hours of unsuccessful searching.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GALINDO HOME CARE INC.	FACILITY NUMBER: 374604434
	VISIT DATE: 09/07/2023

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[CONTINUED FROM LIC 809]

Interviews and records showed: During the 09/01/2023 incident, Staff #1 (S1) initially walked with Client #2 (C2) on a crowded beachside pier, while C1 followed close behind them. At a certain point, C1 stopped following them. It took S1 around ten (10) minutes to realize that C1 was no longer with them. C1 was first recognized as missing around 7:00 PM. S1 and Staff #2 (S2) persistently searched for C1, unsuccessfully. It was not until 9:37 PM that staff first notified law enforcement, and it was not until 11:00 PM that staff first notified C1’s responsible person. Around 11:00 PM, C1 borrowed a phone from a bystander and placed a call to state their location. S2 then picked up C1 around three (3) miles from where S1 last saw C1, then returned C1 to the facility unharmed.

A preponderance of evidence exists to show: During the 09/01/2023 incident, Licensee’s staff did not follow the facility’s Absentee Notification Plan. One (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. LPA also issued Technical Assistance (TA) regarding C1’s Medical Assessment (i.e. LIC602 Physician’s Report), C1’s specific Absentee Notification Plan, and staff alert devices on exterior exit doors.

An exit interview was conducted with Torres, to whom a copy of this report, the LIC809-D, the LIC9201-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/07/2023 05:42 PM - It Cannot Be Edited

Created By: Dang Nguyen On 09/07/2023 at 04:37 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GALINDO HOME CARE INC.	FACILITY NUMBER: 374604434
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/07/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/07/2023 Section Cited HSC 1507.15	1 2 3 4 5 6 7	1507.15 Absentee notification plan for missing residents or participants: “Every community care facility that provides adult residential care… shall…develop and comply with an absentee notification plan for each resident...” The plan shall be part of the written Needs and Services Plan [and] shall include…a requirement that an administrator of the facility, or his or her designee, inform the resident’s or participant’s authorized representative when that resident or participant is missing from the facility and the circumstances…in which [they]…shall notify local law enforcement…”	1 2 3 4 5 6 7	Licensee agreed to draft an Absentee Notification Plan specific to C1, incorporating Licensee’s current knowledge of C1’s habits and SDRC feedback. Licensee agreed to retrain its direct care staff on the facility’s general/default Absentee Notification Plan, plus any client-specific Absentee Notification Plan(s). Licensee agreed to E-mail LPA a copy of the training sign-in sheet and C1’s specific Absentee Notification Plan, by the POC due date.
	8 9 10 11 12 13 14	This requirement was not met, as evidenced by: Based on records and interviews, the licensee did not comply with its absentee notification plan for 1 of 3 clients (C1), which posed a potential safety risk to persons in care.	8 9 10 11 12 13 14
	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:

Lizzette Tellez

LICENSING EVALUATOR NAME:

Dang Nguyen

LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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