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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602274
Report Date: 07/26/2023
Date Signed: 07/26/2023 03:43:43 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
01/21/2022 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20220121102204
FACILITY NAME:SUNRISE WAY RESIDENCE IIFACILITY NUMBER:
374602274
ADMINISTRATOR:NICOLE J. GUIBERTFACILITY TYPE:
735
ADDRESS:161 MARSDEN CTTELEPHONE:
(619) 441-5982
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 6DATE:
07/26/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:House Manager, Ashlee MenefeeTIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff did not store hazardous item inaccessible to client
Staff did not provide supervision to meet client needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was greeted by House Manager, Ahhlee Menefee to whom she identified herself. Administrator, Claudine Griffin joined the meeting via conference call and LPA shared findings.

The Department investigated the above-listed complaint allegations. The investigation consisted of an inspection of the facility, observation, multiple interviews with staff and outside sources, and records review, including client and facility records.

On January 21, 2022, Community Care Licensing (CCL) received a complaint alleging that facility staff did not store a hazardous item inaccessible to a client (C1) [an LIC 811 Confidential Names List was provided to staff to identify the client]. It was specifically alleged that on January 19, 2022, while C1 was at the day program, a staff member observed C1 drinking from a bottle of mouthwash during lunch.
(Continue on LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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 4
Control Number 08-AS-20220121102204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNRISE WAY RESIDENCE II
FACILITY NUMBER: 374602274
VISIT DATE: 07/26/2023
NARRATIVE
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(Continue from LIC9099)

Staff intervened before C1 drank the entire contents of the bottle and collected the mouthwash from C1. Per interviews with outside sources, it was indicated that the mouthwash bottle had a label with the name of a client who also resided at the facility. Interviews with facility staff indicated that each client was provided a plastic container to keep their hygiene items which included a bottle of mouthwash. In addition, each container was labeled with the client’s name, and they were centrally stored in a cabinet located in the common area of the facility. However, according to facility staff, the storage cabinet was kept unlocked and accessible to all the clients. On the morning of January 19, 2022, it appears that C1 obtained the bottle of mouthwash from another client’s plastic container, put it in their lunchbox, and then took it to the day program. According to staff, C1 did not have mouthwash in their plastic container because C1 was required to use a prescribed medicated mouthwash which was stored inside the medicine cabinet. A review of medication records confirmed that staff administered the mouthwash to C1 as prescribed. During a visit to the facility on 1/21/2022, C1’s prescribed mouthwash was observed to be properly secured with all the other medications. After the mouthwash incident with C1, management implemented several procedural changes: 1) staff removed all mouthwash bottles from the clients’ containers and discarded them; 2) staff was instructed to dispense a small portion of mouthwash into a 1-ounce medicine cup for each of the clients to use after brushing their teeth; and 3) all the clients’ plastic containers with hygiene items were kept locked and not accessible to clients.

It was also alleged that staff did not provide supervision to meet client needs. It was specifically alleged that staff did not provide adequate supervision to ensure C1 did not have access to hazardous harmful products. In addition, staff did not inspect C1’s lunchbox as appropriate to ensure C1 did not take unauthorized items to the day program. A review of C1 records indicated that C1 required close supervision at the facility and when they were out in the community because C1 had a history of taking things that belonged to others and would hide them. During multiple interviews with staff and outside sources and a review of C1’s Individual Program Plan (IPP) it was disclosed that C1 had taken and ingested toothpaste on several occasions at the day program. As soon as staff noticed C1 with the toothpaste they were able to confiscate the toothpaste tubes and advised facility staff of the incident and requested staff to inspect C1’s lunch prior to coming to the day program. After the incident with the mouthwash, all staff at the facility received additional training on client supervision and on the proper protocols for handling and storing hygiene items and other chemical supplies. (Continue on LIC9099C)
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20220121102204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SUNRISE WAY RESIDENCE II
FACILITY NUMBER: 374602274
VISIT DATE: 07/26/2023
NARRATIVE
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(Continue from LIC9099C)

In addition, staff were reminded to pack C1’s lunch in a clear plastic bag and to inspect C1’s lunch bag to ensure there were no harmful products in their possession. Per interviews with staff and outside sources, there have not been any similar incidents since January 19, 2022.

The Department has investigated the above-mentioned allegations and has found that there was sufficient evidence to corroborate the above allegations. Therefore, these allegations are deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies were cited per Title 22, Division 6, Chapter 6 of the California Code of Regulations and are listed on LIC 9099-D. A plan of corrections was developed with Administrator.

An exit interview was conducted with Administrator, Claudine Griffin, and a copy of this report, Confidential Name List (LIC 811), along with Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20220121102204
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNRISE WAY RESIDENCE II
FACILITY NUMBER: 374602274
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/25/2023
Section Cited
CCR
80087(g)
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Disinfectants, cleaning solutions….and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidenced by:
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Administrator agreed to provide supporting documentation of the training and the procedure changes that were implemented after the incident. Documentation will be submitted to CCL by POC Date of 8/25/2023.
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Based on observations, interviews, and records review, the licensee did not store a hazardous item inaccessible to a client, (C1). This posed a potential health risk to one of the six clients in care.
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Type B
08/25/2023
Section Cited
CCR
80078(a)
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80078(a) Responsibility for Providing Care and Supervision
The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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Administrator agreed to provide supporting documentation of the training and the procedure changes that were implemented after the incident. Documentation will be submitted to CCL by POC Date of 8/25/2023.
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Based on observations, interviews, and records review, the licensee did not provide adequate supervision to meet client’s (C1) needs. This posed a potential health risk to one of the six 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.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4