<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604526
Report Date: 10/21/2022
Date Signed: 10/21/2022 10:49:59 AM

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
10/18/2022 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20221018101454
FACILITY NAME:SILVER HEART CHATEAUFACILITY NUMBER:
374604526
ADMINISTRATOR:NUCOM, HIDEEN RFACILITY TYPE:
740
ADDRESS:9724 EUCALYPTUS CTTELEPHONE:
(518) 577-3629
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 5DATE:
10/21/2022
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Ma Benilda Rumingan, Licensee's DesigneeTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Facility locked resident in their room.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Ofelia Buenaflor, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with Licensee's designee Ma Benilda Rumingan.

The Department’s investigation consisted of interviews with staff and outside sources, records review of relevant documents pertinent to this investigation, and LPA observation of the facility grounds. On October 18, 2022, it was alleged that staff locked a resident in their room.

Interview with an outside source said that a resident #1 (R1) was attempting to open their room from the inside to exit but was not able to open the door. Staff was informed and walked over to R1’s room to open the door.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
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-20221018101454
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: SILVER HEART CHATEAU
FACILITY NUMBER: 374604526
VISIT DATE: 10/21/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Staff interviewed stated the room was locked due to the wandering of R1. On October 21, 2022, LPA toured the facility and observed that resident #2 (R2) room was locked. The key was located, and the room was unlocked. LPA entered the room and observed R2 was safe and not in any immediate danger.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained during staff and outside source interviews and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee's designee Ma Benilda Rumingan. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to designee Rumingan at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20221018101454
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: SILVER HEART CHATEAU
FACILITY NUMBER: 374604526
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
11/04/2022
Section Cited
CCR
87468.1(a)(6)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in all Facilities (a)(6) … to leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. … this requirement was not met as evidenced by:
1
2
3
4
5
6
7
Staff training will be conducted for all six staff on Personal Rights of Residents in All Facilities and a certificate of completion for all staff will be provided to LPA by POC due date, 11/04/2022.
8
9
10
11
12
13
14
Based on interviews and observations, resident #1 (R1) and resident #2 (R2) were locked in their rooms. This posed an immediate safety risk to R1 and R2, two (2) of five (5) of 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: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3