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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000106
Report Date: 08/07/2023
Date Signed: 08/07/2023 03:01:22 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/31/2023 and conducted by Evaluator Lydia Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230731075443
FACILITY NAME:PROMISES GUEST VILLAGEFACILITY NUMBER:
306000106
ADMINISTRATOR:DANTE ENCARNACIONFACILITY TYPE:
735
ADDRESS:1315-1321 ANAHEIM BLVD.TELEPHONE:
(714) 774-1544
CITY:ANAHEIMSTATE: CAZIP CODE:
92805
CAPACITY:40CENSUS: 40DATE:
08/07/2023
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Maria Rizza EngresoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility lacks Administrator/Designated Administrator Back Up on site
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced 10-Day complaint visit to initiate investigation into the above allegation on 08/03/2023. LPA had to return on today's date to deliver report due to computer malfunction. AD was unavailable on today's date due to taking 2 clients to appointments.
On 08/03/2023, LPA Martinez was granted entry into the facility and met with Office Staff (OS) Maria Rizza Engreso and explained the purpose of the visit. Administrator (AD) Dante Encarnacion arrived shortly after. During visit on 08/03/2023, LPA conducted a walk through of the facility, requested copies of facility's LIC500, LIC308, and Client Roster. LPA also conducted interviews with staff and 11 clients. Regarding the allegation that facility lacks Administrator/Designated Administrator Back Up on site, the investigation revealed the following: LPA conducted interviews with AD and OS Engreso. AD stated he was on vacation the last week of July 2023 and left OS Engreso, who is his Assistant Administrator in charge. OS Engreso does not have an Administrator certificate and lacks the credentials and experience to run the facility. AD admitted he failed to designate a substitute when he is/was not present in the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
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 22-AS-20230731075443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PROMISES GUEST VILLAGE
FACILITY NUMBER: 306000106
VISIT DATE: 08/07/2023
NARRATIVE
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Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the allegation that "Facility lacks Administrator/Designated Administrator Back Up on site" is found to be Substantiated. Citation was issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Maria Rizza Engreso and a copy of this report was sent to email on file.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230731075443
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PROMISES GUEST VILLAGE
FACILITY NUMBER: 306000106
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
CCR
85064(f)
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Administrator Qualifications and Duties. When the administrator is absent from the facility there shall be coverage by a designated substitute, who shall be capable of, and responsible and accountable for, management and administration of the facility.
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Licensee/Administrator will designate a substitute for the facility when he cannot be present. The name of trained designee will be provided to CCL via LIC308 along with updated LIC500 and LIC 9020 by POC due date.
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 This requirement was not met as evidenced by: AD admitted Assistant AD does not have a certificate. AD failed to have designated a substitute when he was not present in the facility. This poses a potential health and safety risk to clients 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: Armando J Lucero
LICENSING EVALUATOR NAME: Lydia Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3