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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604852
Report Date: 09/04/2025
Date Signed: 09/04/2025 07:33:01 PM

Document Has Been Signed on 09/04/2025 07:33 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ORANGE WOOD MANORFACILITY NUMBER:
374604852
ADMINISTRATOR/
DIRECTOR:		ALVARADO, DEBORAHFACILITY TYPE:
735
ADDRESS:1202 SOUTH ORANGETELEPHONE:
(619) 440-0121
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 56CENSUS: 43DATE:
09/04/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:25 PM
MET WITH:Deborah Alvarado, Facility ManagerTIME VISIT/
INSPECTION COMPLETED:
07:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to the facility for a self-reported incident. LPA Lopez identified herself and was granted entry by Facility Manager Deborah Alvarado. LPA stated the purpose of the visit and reviewed the basic elements of the visit with manager Alvarado and Majid Syde, Administrator, who later arrived and joined the visit.

The facility self-reported an incident regarding Client #1 (C1- see Confidential Names List) to Community Care Licensing on 9/04/25. The facility self-reported that on August 29, 2025, C1 eloped from the facility at around 6:00 PM. According to the report and staff #1 (S1), the facility notified law enforcement 24 hours after C1 had not returned, on 08/30/25.

During today’s visit, LPA conducted a health and safety check, observed the clients in care, requested and obtained client records, and interviewed staff. Facility Records show that staff conducted rounds every two hours and notified the Facility Manager of the absence of C1. Staff #2 (S2) said that they saw C1 at around 6 PM at the facility. About 10 minutes later, at 6:10 PM, the S2 was observed that C1 left the facility but thought that they would return as the client usually leaves the premises but returns from their outing for their night medications. During medication pass, at about 7:15 PM, S2 observed that C1 had not returned and logged the information. S2 again did their rounds at 8 PM, and C1 had not returned. According to the log at 11:45 PM, the facility had not observed C1 during their shift and wrote the information into the log. S2 said they contacted law enforcement the following day. According to C1 Physician’s Report, they are able to leave the facility unassisted. According to the S1, they were informed the morning of 09/04/25 by C1’s third-party agency that C1 had been admitted to the hospital.

(Continuation on LIC809-C)
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/04/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/04/2025 07:33 PM - It Cannot Be Edited


Created By: Carmen Lopez On 09/04/2025 at 05:04 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: ORANGE WOOD MANOR
FACILITY NUMBER: 374604852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/05/2025
Section Cited
CCR
80019(e)(2)

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Criminal Record Clearance (e)(2) Obtain a California clearance or a criminal record exemption as required by the Department ... this requirement was not met as evidence by:
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Facility manager agreed they will ensure staff who are scheduled to work for the next month have been background cleared and associated to this facility with the office manager, and communicate with staff updates to LPA by POC due date 09/05/25.
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Based on records review the facility did not ensure a staff (S1) had a criminal record background clearance cleared prior to working at the facility which posed a safety risk to 43 of 43 residents in care.
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Type A
09/05/2025
Section Cited
CCR80019(e)(3)

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Criminal Record Clearance (e)(3) (3) Request a transfer of a criminal record clearance as specified in Section 80019(f) ... this requirement was not met as evidence by:
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Facility manager agreed they will ensure staff who are scheduled to work for the next month have been background cleared and associated to this facility with the office manager, and communicate with staff updates to LPA, by POC due date 09/05/25.
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Based on records review the facility did not ensure a staff (S2) had a criminal record transfer cleared prior to working at the facility which posed a safety risk to 43 of 43 residents 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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/04/2025 07:33 PM - It Cannot Be Edited


Created By: Carmen Lopez On 09/04/2025 at 06:53 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: ORANGE WOOD MANOR
FACILITY NUMBER: 374604852

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/19/2025
Section Cited
CCR
80072(a)(6)(A)

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Personal Rights (A) The licensee shall not be prohibited by this provision from setting curfews or other house rules for the protection of clients... this requirement was not met as evidence by;
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Facility had impleented a log in and out book for clients to sign-in and so the facility is able to determine if they are on the facility premise. This was cleared during the visit.
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Based on records review the facility did not ensure that C1 did not follow their house rules as specified on their admission agreement which posed a safety risk to 1 of 43 client 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.
Robyn Clark
NAME OF LICENSING PROGRAM MANAGER:
Carmen Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2025


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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ORANGE WOOD MANOR
FACILITY NUMBER: 374604852
VISIT DATE: 09/04/2025
NARRATIVE
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(Continuation of LIC809)

Deficiencies were observed and cited, and a Technical Advisory were provided during this visit and may be reviewed on the LIC809-D and TA9102 pages of this report. Civil Penalties are being assessed during this visit and may be found on this report.

An exit interview was conducted with facility manager Deborah Alvarado and a copy of this report, LIC 811, TA9102, civil penalties and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the facility manager Alvarado at the conclusion of the visit. The signature below confirms the documents were received.
NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025
LIC809 (FAS) - (06/04)
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