374604454-5-2-2024-08-AS-LTEZ-D5HSYM-20240522141743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604454
Report Date: 05/02/2024
Date Signed: 05/02/2024 04:49:41 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
02/01/2024 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20240201100243

FACILITY NAME:	HUNTINGTON MANOR		FACILITY NUMBER:	374604454
ADMINISTRATOR:	DERAFERA, TESS		FACILITY TYPE:	740
ADDRESS:	14755 BUDWIN LN		TELEPHONE:	(619) 625-6886
CITY:	POWAY	STATE: CA	ZIP CODE:	92064
CAPACITY:	21	CENSUS: 20	DATE:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Administrator, Tess Derafera		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Neglect resulted in sexual abuse of resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Natasha Persaud Conducted an unannounced visit to conclude the investigation regarding the above-mentioned allegation. LPA met with Administrator, Tess Derafera.

During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged neglect resulted in sexual abuse of Resident #1 (R1). It was reported Resident #2 (R2) sexually assaulted R1. However, evidence obtained revealed R1 was not sexually assaulted by R2 but was sexually assaulted by Staff #1 (S1), which was reported to the facility on 10/25/23. R1’s Physician’s Report dated 05/04/23 indicated a diagnosis of Major Neurocognitive Disorder and R1 required assistance with bathing, dressing/grooming, toileting, and medication management. During R1’s interview they were qualified as alert and oriented and able to state pertinent details. Interviews were conducted with the staff members that were sexually harassed by S1. Staff #2 (S2) reported there was an incident when S2 was changing a resident’s diaper and S1 tried to kiss S2. Continued on an LIC 9099C.

Substantiated

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: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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-20240201100243

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: HUNTINGTON MANOR	FACILITY NUMBER: 374604454
	VISIT DATE: 05/02/2024

NARRATIVE

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Staff #3 (S3) reported S1 asked S3 to have sex, at first S3 thought S1 was joking around, but then S1 started to grab and touch S3. S3 also reported S1 sent nude photographs of themselves, and stalked S3 by going to their house. S3 also stated they were preparing lunch for the residents in the kitchen when S1 came up behind S3 and grabbed their breast on the left side. In addition, S1 pinned S3 up against the kitchen counter and blocked S3 from getting away from S1, then continued requesting S3 to meet up to have sex. S3’s interview revealed S1 told S3 they liked Resident #3’s (R3) face and the form of R3’s private part.

Staff interviews indicated it was reported that S1 massaged R1’s breast and squeezed it then was about to move their mouth to R1’s breast when R1 pushed S1 away. The administrator’s interview revealed S1 was placed on administrative leave and later terminated on 11/01/2023. R1’s interview confirmed they were sexually harassed by S1. Evidence obtained revealed S1 sexually harassed multiple staff members at other facilities. S1 was also terminated at another facility for sexual harassment towards staff, which was documented and signed by S1 as acknowledgment and confirmation. Three (3) different females from three different facilities where S1 once worked who didn’t know each other were all able to confirm, S1 was sexually harassing them and touching them inappropriately.

Based on interviews which were conducted and record review, 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 & Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Tess Derafera whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Residents 1-3 and Staff 1-3].

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240201100243

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: HUNTINGTON MANOR	FACILITY NUMBER: 374604454
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/02/2024 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities: “…residents in privately operated residential care facilities shall have all of the following personal rights:…to be free from mental, physical, or sexual abuse.” This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated Staff #1 was terminated on 11/01/23, which removed the immediate threat, POC corrected.
	8 9 10 11 12 13 14	Based on interviews the licensee did not protect 1 out of 21 residents in care from sexual abuse [R1] which posed an immediate safety and personal rights risk to residents 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	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

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